A Primary Care Performance Measurement Framework for Ontario

Transcription

1 A Primary Care Performance Measurement Framework for Ontario Technical Appendices: Report of the Steering Committee for the Ontario Primary Care Performance Measurement Initiative: Phase One

2 TABLE OF CONTENTS Appendix 1: Ontario Primary Care Performance Measurement Initiative Steering Committee Terms of Reference... 1 Appendix 2: Ontario Primary Care Performance Measurement Initiative Measures Working Group Terms of Reference... 3 Appendix 3: Ontario Primary Care Performance Measurement Initiative Technical Working Group Terms of Reference... 7 Appendix 4: Summary Tables by Availability Appendix 5: Summary Tables by Data Source Appendix 6: Access Domain SMDs... 1 Appendix 7: Patient-Centredness Domain SMDs Appendix 8: Integration Domain SMDs Appendix 9: Effectiveness Domain SMDs Appendix 10: Focus on Population Health Domain SMDs Appendix 11: Efficiency Domain SMDs Appendix 12: Safety Domain SMDs Appendix 13: Appropriate Resources Domain SMDs Appendix 14: Recommended Population Characteristics for Assessing Primary Care Equity ISBN (PDF)

3 Appendix 1: Ontario Primary Care Performance Measurement Initiative Steering Committee Terms of Reference INTRODUCTION: Health Quality Ontario is collaborating with key primary care stakeholders through the Ontario Primary Care Performance Measurement Steering Committee to provide leadership on a coordinated and sustainable approach to measure and report on primary care performance. The goal is to determine what aspects of primary care performance are most valuable to measure on a regular basis and the data sources and required to support them. Agreement on these measures and support for their collection will drive short-term improvements, support longer term goals and track the impact of policy changes and investments. Performance measurement can inform service planning, performance monitoring and quality improvement. STEERING COMMITTEE PURPOSE: The purpose of the Ontario Primary Care Performance Measurement Steering Committee is to advise on the development, implementation and evaluation of a Primary Care Performance Measurement framework for Ontario, identify and oversee working groups and technical advisory group composition, and advise on activities related to the ongoing governance of the Primary Care Performance Measurement framework. COMMITMENT: Members of the Steering Committee will be invited to serve until: a) June 2014 to advise on the development of the PCPM framework b) December 2016 (expected date) to advise on activities related to the ongoing governance, implementation and evaluation of the PCPM framework RESPONSIBILITIES: Specifically, members of the Steering Committee will provide advice to HQO and other stakeholders with respect to: Securing agreement among key stakeholders on primary care performance measurement priorities Development of a primary care performance measurement framework Composition and terms of reference for Working Groups that will be tasked with recommending specific performance measures and data sources Final selection of performance measures and data sources Identification and selection of a central data repository Ongoing governance processes for guiding the implementation and reporting of primary care performance measurement Identification of opportunities and risks MEETING FORMAT: 1 It is anticipated that Steering Committee meetings will be scheduled quarterly and will be held face-to-face or via teleconference with WebEx option

4 Agenda and supporting documentation will be circulated to Steering Committee members at least 48 hours prior to meetings Steering Committee members should assume that all members have read the supporting documentation prior to the meeting Steering Committee members are encouraged to attend meetings regularly. In circumstances where a member is not able to attend a meeting, a consistent alternate representative should attend the meeting on their behalf Steering Committee members will strive for consensus when advising the Primary Care Performance Measurement Core Team and, in the interest of time and remaining on task, the chairs may defer items that need further discussion to a later date. When consensus cannot be reached, a simple majority vote will be applied to those members in attendance GUIDING NORMS: Every member is responsible for the progress and success of the initiative Every member is responsible for ensuring that their voice is heard Every member should be specific, constructive, and solution-oriented with their feedback Every member should be a participant, without dominating Every member should strive to apply the resultant framework to the ongoing work of their organization MEMBERSHIP: Members have been selected for their primary care measurement leadership in Ontario and their ability to influence change in their respective organizations. 2

5 Appendix 2: Ontario Primary Care Performance Measurement Initiative Measures Working Group Terms of Reference BACKGROUND AND PURPOSE Health Quality Ontario (HQO) is collaborating with key primary care stakeholders through the Ontario Primary Care Performance Measurement (PCPM) Steering Committee to provide leadership on a coordinated and sustainable approach to measure and report on primary care performance. Goal The goal is to determine what aspects of primary care performance are most valuable to measure on a regular basis and the data sources and required. Agreement on performance measures and support for their collection, analysis and reporting will drive system improvements, track the impact of policy changes and investments and inform service planning, performance monitoring and quality improvement at the practice level. PCPM Summit Recognizing the need for coordination and alignment among current and proposed primary care performance measurement initiatives, HQO and the Canadian Institute for Health Information (CIHI), in partnership with others, organized a PCPM Summit in November, 2012 to begin to identify primary care performance measurement priorities at the practice/organization and system (community, LHIN and provincial) levels. Through the use of consensus building and electronic voting techniques, senior leaders from participating primary care stakeholder associations: 1. Identified preliminary performance measurement priorities that would be valuable to measure on a regular basis to inform decision-making at the practice and system levels; 2. Committed to engage in ongoing collaborative work. The Summit Proceedings report can be found on HQO & CIHI websites. PCPM Stakeholder Survey During spring 2013 a PCPM stakeholder survey was circulated by the 15 organizations represented on the Steering Committee to engage their members and solicit their views on which aspects of primary care performance would be valuable to measure. Ontario PCPM Framework Informed by the Summit results and over 850 responses received from the stakeholder survey, the Steering Committee identified the list of measurement priorities for the system level and the practice level. 3

6 MEASURES WORKING GROUP ROLE Select a set of preferred specific measures for the PCPM framework guided by the following considerations: Opportunity for comparison with practice, regional, national and/ or international PC performance Likelihood that the measure will inform quality improvement Evidence that the measure will address one or more aspects of the Triple Aim: Improving the patient experience of care Improving the health of the population Reducing/controlling the per-capita cost of health care Validity/ Reliability Alignment with existing performance measurement initiatives in Ontario Current availability of data (secondary consideration) COMMITMENT Members of the Measures Working Group will participate in a series of three surveys that will be circulated over the summer/ fall of 2013 and winter of 2014 to prioritize a set of generic measures for the framework measurement priorities. Each survey will cover a different group of performance measures. The first will include measures of Access, Integration and Patient- Centredness; the second will address Effectiveness and Focus on Population Health; and the third will cover Safety, Efficiency and Appropriate Resources. Following each survey, members of the Measures Working Group will meet in-person (around 4 meetings) to select a set of preferred specific measures informed by the survey results. The list of preferred specific measures will be brought forward to the Technical Working Group members who will advise on implementation and for data extraction, analysis and reporting. The Working Group will strive for consensus on the preferred measures to be included in the PCPM framework. When consensus cannot be reached, the item will be referred to the Steering Committee for a decision. STEERING COMMITTEE ROLE 4 Advise on the development, implementation and evaluation of the PCPM framework. Advise on activities related to the ongoing governance of the PCPM framework. Identify and oversee the Measures Working Group and the Technical Working Group. Informed by the working groups input, develop: Recommendations for measures that can be collected/reported upon immediately Recommendations for measures that require new for implementation Recommendations for development

7 Recommendations for a structure and process for the ongoing governance of the PCPM framework HQO PCPM CORE TEAM ROLE Support the Steering Committee and working groups in meeting their objectives. Provide relevant background material and facilitate the working groups meetings. Refresh the pre-summit environmental scan on measures and identify current availability, potential data sources, and information on validity and reliability. Screen the preliminary list of measures identified through the environmental scan in preparation for the online survey that will be circulated to the Measures Working Group. Provide support for the development and administration of the Measures Working online survey. Support and inform the Measures Working Group meetings by developing relevant background material describing the specific measures current availability, potential data source and validity/ reliability. Support and inform the Technical Working Group meetings by developing relevant background material describing the technical specifications for the selected measures. Compile and document the Steering Committee recommendations/ decisions and support posting relevant content on the HQO website. Support the Steering Committee activities related to the ongoing implementation and governance of the PCPM framework. TECHNICAL WORKING GROUP ROLE Confirm data source, numerator and denominator for the measures selected by the Measures Working Group. Recommend existing and required for data collection analysis and reporting. Identify data and methodology to apply an equity lens to the measures. Identify data and methodology for adjustment for patient/ population characteristics and differences in health care environment for comparisons across practices/ organizations or geographic areas. REPORTING RELATIONSHIP The working groups have an advisory role to the Steering Committee which oversees the initiative. The recommendations of the working groups will be brought to the Steering Committee for approval. MEETING FORMAT 5 It is anticipated that the Measures Working Group meetings will be face-to-face and scheduled over the course of summer/ fall of 2013 and winter of Agenda and supporting documentation will be circulated to the group members at least three working days prior to meetings.

8 Working group members should assume that all members have read the supporting documentation prior to the meeting. Working group members will strive for consensus. When consensus cannot be reached, a simple majority vote will be applied to those members in attendance. Alternatively, the issue may be referred to the Steering Committee for a decision. GUIDING NORMS Every member is responsible for the progress and success of the initiative Every member is responsible for ensuring that their voice is heard Every member should be specific, constructive, and solution-oriented with their feedback Every member should be a participant, without dominating Every member should strive to apply the resultant framework to the ongoing work of their organization 6

9 Appendix 3: Ontario Primary Care Performance Measurement Initiative Technical Working Group Terms of Reference BACKGROUND AND PURPOSE Health Quality Ontario (HQO) is collaborating with key primary care stakeholders through the Ontario Primary Care Performance Measurement (PCPM) Steering Committee to provide leadership on a coordinated and sustainable approach to measure and report on primary care performance. Goal The goal is to determine what aspects of primary care performance are most valuable to measure on a regular basis and the data sources and required. Agreement on performance measures and support for their collection, analysis and reporting will drive system improvements, track the impact of policy changes and investments and inform service planning, performance monitoring and quality improvement at the practice level. PCPM Summit Recognizing the need for coordination and alignment among current and proposed primary care performance measurement initiatives, HQO and the Canadian Institute for Health Information (CIHI), in partnership with others, organized a PCPM Summit in November, 2012 to begin to identify primary care performance measurement priorities at the practice/organization and system (community, LHIN and provincial) levels. Through the use of consensus building and electronic voting techniques, senior leaders from participating primary care stakeholder associations: 1. Identified preliminary performance measurement priorities that would be valuable to measure on a regular basis to inform decision-making at the practice and system levels; 2. Committed to engage in ongoing collaborative work. The Summit Proceedings report can be found on the HQO & CIHI websites. PCPM Stakeholder Survey During spring 2013 a PCPM stakeholder survey was circulated by the 15 organizations represented on the Steering Committee to engage their members and solicit their views on which aspects of primary care performance would be valuable to measure. 7

10 Ontario PCPM Framework Informed by the Summit results and over 850 responses received from the stakeholder survey, the Steering Committee identified the list of measurement priorities for the system level and the practice level. TECHNICAL WORKING GROUP ROLE Confirm data source, numerator and denominator for the measures selected by the Measures Working Group. Recommend existing and required for data collection analysis and reporting. Identify data and methodology to apply an equity lens to the measures. Identify data and methodology for adjustment for patient/ population characteristics and differences in health care environment for comparisons across practices/ organizations or geographic areas. COMMITMENT Members of the Technical Working Group will be invited to in-person meetings (around 5 meetings) over the summer/ fall of 2013 and winter of 2014 where the list of measures selected by the Measures Working Group will be presented to advise on implementation and requirement for data collection, analysis and reporting. The list of preferred measures will be selected by the Measures Working Group and brought forward to the Technical Working Group members. The working groups will strive for consensus on the preferred measures to be included in the PCPM framework. When consensus cannot be reached, in the interest of time and remaining on task, the chair may defer discussion items for the Steering committee to make a decision. STEERING COMMITTEE ROLE Advise on the development, implementation and evaluation of the PCPM framework. Advise on activities related to the ongoing governance of the PCPM framework. Identify and oversee the Measures Working Group and the Technical Working Group. Informed by the working groups input, develop: Recommendations for measures that can be collected/reported upon immediately Recommendations for measures that require new for implementation Recommendations for development Recommendations for a structure and process for the ongoing governance of the PCPM framework Organizations represented on the Steering Committee are listed in Appendix 1. 8

11 HQO PCPM CORE TEAM ROLE Support the Steering Committee and working groups in meeting their objectives. Provide relevant background material and facilitate the working groups meetings. Refresh the pre-summit environmental scan on measures and identify current availability, potential data sources, and information on validity and reliability. Screen the preliminary list of measures identified through the environmental scan in preparation for the online survey that will be circulated to the Measures Working Group. Provide support for the development and administration of the Measures Working online survey. Support and inform the Measures Working Group meetings by developing relevant background material describing the specific measures current availability, potential data source and validity/ reliability. Support and inform the Technical Working Group meetings by developing relevant background material describing the technical specifications for the selected measures. Compile and document the Steering Committee recommendations/ decisions and support posting relevant content on the HQO website. Support the Steering Committee activities related to the ongoing implementation and governance of the PCPM framework MEASURES WORKING GROUP ROLE Select a set of preferred specific measures for the PCPM framework guided by the following considerations: Opportunity for comparison with practice, regional, national and/ or international PC performance Likelihood that the measure will inform quality improvement Evidence that the measure will address one or more aspects of the Triple Aim: Improving the patient experience of care Improving the health of the population Reducing/controlling the per-capita cost of health care Validity/ Reliability Alignment with existing performance measurement initiatives in Ontario Current availability of data (secondary consideration) REPORTING RELATIONSHIP The working groups have an advisory role to the Steering Committee which oversees the initiative. The recommendations of the working groups will be brought to the Steering Committee for approval. 9

12 MEETING FORMAT It is anticipated that the Measures Working Group meetings will be face-to-face and scheduled over the course of summer/ fall of 2013 and winter of Agenda and supporting documentation will be circulated to the group members at least three working days prior to meetings. Working group members should assume that all members have read the supporting documentation prior to the meeting. Working group members will strive for consensus. When consensus cannot be reached, a simple majority vote will be applied to those members in attendance. Alternatively, the issue may be referred to the Steering Committee for a decision. GUIDING NORMS Every member is responsible for the progress and success of the initiative Every member is responsible for ensuring that their voice is heard Every member should be specific, constructive, and solution-oriented with their feedback Every member should be a participant, without dominating Every member should strive to apply the resultant framework to the ongoing work of their organization 10

13 Appendix 4: Summary Tables by Availability Availability of Selected Measures (Practice level)* Domain Number of measures Currently reported Currently reported but modified wording recommended Not currently available but could be reported using existing infrastruct ure Not currently available but included in survey tool under development ; required for data collection, analysis and reporting Measures not currently available; new required for data collection, analysis and reporting Total Access Patient- Centredness Integration Effectiveness Focus on Population Health Efficiency Safety Appropriate NA NA NA NA NA NA 11

14 Availability of Selected Measures (Practice level)* Domain Number of measures Resources Total Equity Cross-cutting domain- Analysis will be based on 13 population characteristics: age, gender/sex, urban/rural location, ethno-cultural identity, disability, social support, income, education, sexual orientation/identity, language, immigration, aboriginal status, employment status, mental health status * Refers to province-wide (vs. local) availability For example, HQO-ICES Primary Care Practice Report for system: for example HCES HQO Primary Care Patient Experience Survey For example, EMR-based measures 12

15 Availability of Selected Measures (System Level)* Domain Number of measures Currently reported Currently reported but modified wording recommended Not currently available but could be reported using existing Measures not currently available; new required for data collection, analysis and reporting Total Access Patient- Centredness Integration Effectiveness Focus on Population Health Efficiency Safety Appropriate Resources Total Equity Cross-cutting domain- Analysis will be based on 13 population characteristics: age, gender/sex, urban/rural location, ethno-cultural identity, disability, social support, income, education, sexual orientation/identity, language, immigration, aboriginal status, employment status, mental health status 13

16 * Refers to province-wide (vs. local) availability For example, HQO-ICES Primary Care Practice Report, MOHLTC Health Care Experience Survey For example, EMR-based measures 14

17 Appendix 5: Summary Tables by Data Source Number of measures by current /potential data source (Practice level) Administrative data* EMR data Practice level patient experience survey Total Access Patient-Centredness o Integration Effectiveness Focus on Population Health Efficiency Safety Appropriate Resources NA NA NA NA Total Equity Cross-cutting domain. Analysis will be based on 14 population characteristics: age, gender/sex, urban/rural location, ethno-cultural identity, disability, social support, income, education, sexual orientation/identity, language, immigration, aboriginal status, employment status, mental health status * e.g., Institute for Clinical Evaluative Sciences, Ministry of Health and Long-Term Care- Health Analytics Branch, Cancer Care Ontario. 15

18 e.g., Electronic Medical Record Administrative data Linked Database (EMRALD), Canadian Primary Care Sentinel Surveillance Network (CPCSSN), Business Intelligent Reporting System (BIRT) Number of measures by current /potential data source (System level) Administrative data* EMR data Population survey data Providerreported Organizationreported Total Access Patient- Centredness Integration Effectiveness Focus on Population Health Efficiency Safety Appropriate Resources Total Equity Cross-cutting domain- Analysis will be based on 14 population characteristics: age, gender/sex, urban/rural location, ethno-cultural identity, disability, social support, income, education, sexual orientation/identity, language, immigration, aboriginal status, employment status, mental health status 16

19 * e.g., Institute for Clinical Evaluative Sciences, Ministry of Health and Long-Term Care- Health Analytics Branch, Cancer Care Ontario e.g., Electronic Medical Record Administrative Data Linked Database, Canadian Primary Care Sentinel Surveillance Network e.g., Health Care Experience Survey, Commonwealth Fund International Health Policy Survey, Canadian Community Health Survey e.g., National Physician Survey No source currently available Note: Some provider-reported measures could also be organization-reported and vice versa 17

20 Appendix 6: Access Domain SMDs Measurement priority Extent of (avoidable) emergency department, walk-in clinic, urgent care centre use Measure name Level of reporting Availability Measure description Rating* 4.47 Patient reported reasons for avoidable emergency department use System level Measure currently reported in recommended form (province/lhin) Percentage of people who report going to the emergency department for reasons that were potentially avoidable Numerator Number of respondents, who visited an emergency department in the last 12 months because: your [fill fd_type]** was not available you could not get an appointment with your [fill fd_type] it was faster to go to the emergency the emergency was closer other, specify Reported separately Respondents who have been to emergency department in the past 12 months Measure source/ data source / data elements/ Base (respondents who answer yes): Have you been to an emergency department because you were sick or for a health related problem in the last 12 months? Excludes: don t know refused Measure source: Health Care Experience Survey (HCES) Data source: Health Care Experience Survey (HCES), provided by Health Analytics Branch, Ministry of Health and Long-Term Care Survey question: Which of the following was the MAIN reason you went to emergency rather than to you [fill fd_type]? 18 it was an emergency your [fill fd_type] was not available you could not get an appointment with your [fill fd_type]

21 Timing and frequency of data release it was faster to go to the emergency the emergency was closer [fill fd_type] advised you to go to emergency [fill fd_type] works out of the emergency other, specify don't know refused Quarterly *This rating is for the generic measure potentially avoidable emergency department use which included this specific measure along with other potential measures of this aspect of primary care performance. **fd_type is the variable in the HCES used to denote the type of provider (family doctor/ nurse practitioner) the respondent has seen. 19

22 Measurement priority Measure name Extent of (avoidable) emergency department, walk-in clinic, urgent care centre use Patient reported reasons for avoidable walk-in clinic use MEASURE DESCRIPTION Level of reporting Availability Measure description System level Measure currently reported in recommended form (province/lhin) Percentage of people who report going to a walk-in clinic for reasons that were potentially avoidable Rating* 4.68 Numerator Number of respondents that report visiting a walk-in clinic because: your [fill fd_type]** was not available you could not get an appointment with your [fill fd_type] it was faster to go to the walk-in the walk-in was closer [fill fd_type] advised you to go to a walk-in it was a follow-up to a previous visit at the walk-in other, specify Measure source/ data source / data elements/ Reported separately Respondents who have been to a walk-in clinic in the past 12 months Base (respondents who answer yes): Have you been to a walk in clinic because you were sick or for a health related problem in the 12 months? Excludes: don t know refused Measure source: Health Care Experience Survey (HCES) Data source: Health Care Experience Survey (HCES), provided by Health Analytics Branch, Ministry of Health and Long-Term Care Survey question: Which of the following is the MAIN reason you went to a walk-in rather than to you [fill fd_type]? 20 your [fill fd_type] was not available you could not get an appointment with your [fill fd_type] it was faster to go to the walk-in the walk-in was closer [fill fd_type] advised you to go to a walk-in it was a follow-up to a previous visit at the walk-in other, specify

23 Timing and frequency of data release don't know refused Quarterly (system level) *This rating is for the generic measure potentially avoidable walk-in clinic use which included this specific measure along with other potential measures of this aspect of primary care performance. **fd_type is the variable in the HCES used to denote the type of provider (family doctor/ nurse practitioner) the respondent has seen. 21

24 Measurement priority Access to a regular primary care provider Measure name Attachment to a regular primary care provider Level of reporting Availability Measure description Rating* 5.84 System level Practice level System level: Measure currently reported but modified wording recommended (province/lhin) Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of people/patients who report that they have a family physician or nurse practitioner Numerator Number of respondents who reported having a family doctor, a general practitioner, family physician or nurse practitioner All respondents Measure source/ data source / data elements/ Excludes: don t know refused Measure source: Modified Health Care Experience Survey (HCES) System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey Proposed survey question: Do you have a family doctor, a general practitioner or GP, family physician or nurse practitioner? yes no don t know refused Original Question (placeholder): Do you have a family doctor, a general practitioner or GP, or nurse practitioner that you see for regular check-ups, when you are sick and so on? 22 yes no don t know

25 refused Timing and Quarterly (system level) frequency of data release *This rating is for the generic measure percentage of population with regular primary care provider which included this specific measure along with other potential measures of this aspect of primary care performance. 23

26 Measurement priority Access to a regular primary care provider Measure name Continuity of care with a primary care physician Level of reporting Availability Measure description Rating* System level: 5.21 Practice level: 5.26 Numerator System level Practice level System level: Measure currently reported in recommended form (province/lhin) Practice level: Measure currently reported in recommended form Percentage of total primary care visits that are made to the physician with whom the patient is rostered or virtually rostered Percentage of primary care visits that are made to the physician to whom the patient is rostered or virtually rostered Measure source/ data source / data elements/ Timing and frequency of data release Number of total primary care visits per patient Excludes: Patients who have not had 3 or more primary care visits within the requisite time period Measure source: Primary Care Practice Reports System level data source: Client Agency Patient Enrolment (CAPE), Ontario Health Insurance Plan (OHIP), provided by ICES Practice level data source: Client Agency Patient Enrolment (CAPE), Ontario Health Insurance Plan (OHIP), provided by ICES System level: potentially available bi-annually Practice level: available bi-annually Infrastructure development is needed to capture nurse practitioners as well Note: continuity of care is a construct that can be measured using a number of different methodologies; an appropriate and aligned methodology will be selected for this measure *This rating is for the generic measure Continuity of care with a primary care physician which included this specific measure along with other potential measures of this aspect of primary care performance. 24

27 Measurement priority Measure name Level of reporting Availability Measure description Access to a regular primary care provider Difficulties accessing routine or ongoing primary care System level Rating* System level: 5.37 Measure currently reported in recommended form (province/lhin) Percentage of patients who report that they experienced difficulties obtaining required routine or ongoing primary care services from their provider over the past 12 months, for themselves, their children, elderly family member or disabled family members Numerator Number of respondents who reported experiencing difficulties obtaining required routine or ongoing primary health care services for themselves or a family member in the past 12 months All respondents Measure source/ data source / data elements/ Timing and frequency of data release Excludes: Respondents who reported not requiring any routine or ongoing care for himself/herself or a family member in the past 12 months Measure source: CIHI Pan-Canadian Primary Health care Indicator Project Data source: Canadian Community Health Survey (CCHS) Survey question: In the past 12 months, did you ever experience any difficulties getting the routine or on- going ^DT_Family* needed? Yes No (Go to ACC_R60) DK, RF Annually *This rating is for the generic measure ease of obtaining care from regular primary care provider which included this specific measure along with other potential measures of this aspect of primary care performance. **DT_Family is a variable used in the CCHS to denote the following If one person household then ^DT_YourFamily = " " If one person household, ^DT_Family = "you" Else, ^DT_YourFamily = "for yourself or a family member" Else, ^DT_Family = "you or a family member" 25

28 Measurement priority MEASURE DESCRIPTION Measure name Level of reporting Availability Access to a regular primary care provider Wheelchair accessibility of primary care practices System level Measure not currently available; new required for data collection, analysis and reporting (province/lhin) Measure Percentage of practices/organizations that report having arrangements description for wheelchair access Rating* 5.37 Numerator Measure source/ data source / data elements/ Timing and frequency of data release Number of practices that reported having arrangements for wheelchair access Building in which practice is located Waiting room Examining room Washroom Examining table Reported separately All respondents Measure source: Quality indicators for General Practice (Literature)** Potential data source: Organization reported Proposed survey question: Does your practice provide access to the following for patients who use wheelchairs? (Check all that apply) Building in which practice is located Waiting room Examining room Washroom Examining table *This rating is for the generic measure ease of obtaining care from regular primary care provider which included this specific measure along with other potential measures of this aspect of primary care performance. **Reference: Campbell S.M., Roland M.O., Quayle J.A., Buetow S.A., Shekele P.G. Quality indicators for general practice: which ones can general practitioners and health authority managers agree are important and how useful are they? Journal of Public Health Medicine. 1998;20(4):

29 Measurement priority Measure name Access to an inter-professional primary care team Patients access to interdisciplinary care Level of reporting Availability Measure description Rating* System level: 5.47 Practice level: 4.37 System level Practice level System level: Measure not currently available but could be reported using existing (province/ LHIN) Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients who report accessing interprofessional health care providers at the place they usually receive care, by type of provider Numerator Measure source/ data source / data elements/ Number of patients accessing interdisciplinary healthcare providers, at the place they usually receive care, by type of provider: Nurse practitioner (NP) Nurse Occupational therapist (OT) Physiotherapist (PT) Dietitian Social worker Health educator Psychologist Pharmacist, and Mental health worker Physician assistant Other professionals (e.g. chiropodist, etc.) Reported separately All respondents Measure source: Modified Program Evaluation Framework: Alberta System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey and EMR/EHR data extraction Proposed survey question: Have you seen the any of the following health care providers over the past 12 months? Nurse practitioner (NP) Nurse Occupational therapist (OT) Physiotherapist (PT) Dietitian 27

30 Social worker Health educator Psychologist Pharmacist, and Mental health worker Physician assistant Other professionals (e.g. chiropodist, etc.) Original survey question: Percentage of patients accessing inter- professional health care providers, by type of provider in the last 12 months: Timing and frequency of data release Nurse practitioner (NP) Nurse Occupational therapist (OT) Physiotherapist (PT) Dietitian Social worker Health educator Psychologist Pharmacist, and Other professionals (e.g. chiropodist, etc.) Other relevant information *This rating is for the generic measure percentage of Ontarians/ patients accessing interprofessional primary care team which included this specific measure along with other potential measures of this aspect of primary care performance. 28

31 Measurement priority Access to an inter-professional primary care team Measure Name Primary care practices that are inter-professional Level of reporting Availability Measure description Rating* 5.00 System level Measure not currently available; new required for data collection, analysis and reporting (province/lhin) Percentage of primary care practices/organizations that report having various types of health care providers, by type of provider Numerator Number of respondents that reported having the following types of providers: Physician: # FTEs: Physician specialist: # FTEs: Nurse practitioner: # FTEs: Nurse: # FTEs: Occupational therapist (OT): # FTEs: Physiotherapist (PT): # FTEs: Dietitian: # FTEs: Social worker: # FTEs: Health educator: # FTEs: Psychologist: # FTEs: Pharmacist: # FTEs: Mental health worker: # FTEs: Physician assistant: # FTEs: Registered nurse: # FTEs: Audiologist: # FTEs: Chiropractor: # FTEs: Optometrist: # FTEs: Speech language pathologist: # FTEs: Respiratory therapist: # FTEs: Other (please specify): Reported by number of providers and FTEs for each type of provider All respondents 29 Measure source/ data source / data elements/ Measure source: Modified CIHI Measuring Organizational Attributes of Primary Health Care Survey Potential data source: Organization reported Proposed survey question: Please complete the number of staff in your clinic and their FTEs:

32 Physician: # FTEs: Physician specialist: # FTEs: Nurse practitioner: # FTEs: Nurse: # FTEs: Occupational therapist (OT): # FTEs: Physiotherapist (PT): # FTEs: Dietitian: # FTEs: Social worker: # FTEs: Health educator: # FTEs: Psychologist: # FTEs: Pharmacist: # FTEs: Mental health worker: # FTEs: Physician assistant: # FTEs: Registered nurse: # FTEs: Audiologist: # FTEs: Chiropractor: # FTEs: Optometrist: # FTEs: Speech language pathologist: # FTEs: Respiratory therapist: # FTEs: Other (please specify): Original survey question: Please complete the number of staff in your clinic and their FTEs: Nurse practitioner: # FTEs: Occupational therapist (OT): # FTEs: Physiotherapist (PT): # FTEs: Dietitian: # FTEs: Social worker: # FTEs: Psychologist: # FTEs: Psychologist: # FTEs: Pharmacist: # FTEs: Physician assistant: # FTEs: Registered nurse: # FTEs: Audiologist: # FTEs: Chiropractor: # FTEs: Optometrist: # FTEs: Speech language pathologist: # FTEs: Respiratory therapist: # FTEs: Psycho-geriatric: # FTEs: Other (please specify): Timing and frequency of data release 30

33 Other relevant information *This rating is for the generic measure percentage of primary care practices that are interprofessional team which included this specific measure along with other potential measures of this aspect of primary care performance. 31

34 Measurement priority Measure Name Timely access at regular place of care Timely access during regular hours Level of reporting Availability Measure description System level Practice level Rating* System level: 5.26 Practice level: 5.63 System level: Measure currently reported in recommended form (province/lhin) Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients who report that they were able to see their family physician or nurse-practitioner on the same or next day Numerator Number of respondents who saw their health care provider or someone else in the office on the same or next day Number of respondents who saw their regular health care provider or someone else in the office when they were sick or were concerned that they had a health problem in the past 12 months Measure source/ data source/ data elements/ Base (respondents who answer yes to both questions): Not counting yearly check-ups or monitoring of an ongoing health issue, in the last 12 months did you want to see your [fill fd_type]** because you were sick or were concerned that you had a health problem? Did you actually see a doctor? [or someone else in the office or both] Excludes: never tried to do this/never needed care don't know refused Measure source: Health Care Experience Survey (HCES) System level data source: Health Care Experience Survey (HCES), provided by Health Analytics Branch, Ministry of Health and Long-Term Care Practice level potential data source: Practice level patient experience survey 32 Survey question:

35 How many days did it take from when you first tried to see your family doctor/ nurse practitioner to when you actually saw him/her or someone else in their office? Timing and frequency of data release saw the doctor the same day saw doctor next day Enter number of days twenty or more days don't know refused Quarterly (system level) *This rating is for the generic measure timely access during regular hours which included this specific measure along with other potential measures of this aspect of primary care performance. **fd_type is the variable in the HCES used to denote the type of provider (family doctor/ nurse practitioner) the respondent has seen. 33

36 Measurement priority Access to after-hours care (telephone and in-person) Measure Name Patient reported access to after-hours and weekend care Level of reporting Availability Measure description Rating* System level: 4.42 Practice level: 4.42 System level Practice level System level: Measure currently reported but modified wording recommended (province/ LHIN) Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients/people who report that getting medical care in the evening, weekend, or a public holiday was difficult Numerator Measure source/data source/ data elements/ Number of respondents who reported how easy they found getting medical care in the evening, on a weekend, or a public holiday without going to the emergency department as very easy somewhat easy somewhat difficult very difficult never tried to do this/never needed care don't know refused All respondents Excludes: never tried to do this/never needed care don't know refused Measure source: Modified - Health care experience survey (HCES) System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey Proposed survey question: The last time when you needed medical care in the evening, on a weekend, or on a public holiday, how easy or difficult was it to get care without going to the emergency department, walk-in clinic or urgent care centre? 34

37 very easy somewhat easy somewhat difficult very difficult never tried to do this/never needed care don't know refused Original survey question: The last time when you needed medical care in the evening, on a weekend, or on a public holiday, how easy or difficult was it to get care without going to the emergency department? very easy somewhat easy somewhat difficult very difficult never tried to do this/never needed care don't know refused Timing and frequency of data release Quarterly (system level) Other relevant information *This rating is for the generic measure access to after hour care - general which included this specific measure along with other potential measures of this aspect of primary care performance. 35

38 Measurement priority Measure Name Access to after-hours care (telephone and in-person) Provider reported access to after-hours care and weekend care Level of reporting Availability Measure description Rating* 4.42 System level Measure not currently available; new required for data collection, analysis and reporting (province/lhin) Percentage of primary care providers who report providing after-hours access for their patients during evenings and nights on weekdays and on weekends Numerator Number of respondents who reported providing access during evenings and nights on weekdays and on Saturdays and Sundays to their patients for (non-emergency) medical services Not applicable (I am always available for my patients) I am available on rotating basis with a group of FP/GPs All respondents Measure source/data source/ data elements/ Measure source: Modified QualicoPC- Family Physician Survey Potential data source: Organization reported Proposed survey question: During evenings and nights on weekdays and on Saturdays and Sundays, how do you provide access to your patients for (non-emergency) medical services? Not applicable (I am always available for my patients) I am available on rotating basis with a group of FP/GPs I am not available, but other FP/GPs are available (on a rotating basis) Other physicians (not FP/GPs) provide out-of-hours care I request patients to call Telehealth I request patients to go to the Emergency Department I request patients to go to a walk-in clinic No arrangements for after-hours and weekend access to care Original survey question: During evenings and nights on weekdays, how do you provide access to your patients for (non-emergency) medical services? 36 Not applicable (I am always available for my patients) I am available on rotating basis with a group of FP/GPs I am not available, but other FP/GPs are available (on a rotating basis)

39 Other physicians (not FP/GPs) provide out-of-hours care Other arrangements Timing and frequency of data release Other relevant information *This rating is for the generic measure access to after hour care - general which included this specific measure along with other potential measures of this aspect of primary care performance. 37

40 Measurement priority Access to non face-to-face care (e.g. telephone, , etc.) Measure Name Same day response to an office call during regular hours Level of reporting Availability Measure description System level Practice level System level: Measure currently reported but modified wording recommended (Province/Other provinces/canada/international) Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients who report that, when they call their regular family physician s or nurse practitioner s office with a medical question or concern during regular office hours, they get an answer on the same day Rating* System level: 4.42 Practice level: 4.58 Numerator Number of respondents who reported often or always getting an answer from their regular [family doctor s/nurse practitioner s] office on the same day Measure source/data source/ data elements/ Respondents who have a regular doctor/place and called their regular doctor s office with a medical question or concern during regular practice hours Base (respondents who answered that they had a regular doctor or regular place): Regular doctor or place? Excludes: Never tried to contact by telephone Declined to answer Measure source: Modified Commonwealth Fund International Health Policy Survey 2013 System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey Proposed survey question: When you call your regular [family doctor s, nurse practitioner s] office with a medical concern during regular practice hours, how often do you get an answer that same day? 38

41 Always Often Sometimes Rarely or never Never tried to contact by telephone Decline to answer Original survey question: When you call your regular doctor s office with a medical concern during regular practice hours, how often do you get an answer that same day? Timing and frequency of data release Always Often Sometimes Rarely or never Never tried to contact by telephone Decline to answer Every three years *This rating is for the generic measure access to care by telephone which included this specific measure along with other potential measures of this aspect of primary care performance. 39

42 Measurement priority Access to non face-to-face care (e.g. telephone, , etc.) Measure Name Patient access to primary care provider by Level of reporting Availability Measure description System level Practice level System level: Measure currently reported in recommended form (province/lhin) Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients who report that they have ed their family physician/nurse-practitioner with a medical question in the last 12 months Rating* System level: 4.47 Practice level: 4.42 Numerator Number of respondents who reported ing a medical question to their regular family doctor Respondents who have a regular health care provider or family doctor Data source / data elements/ Base (respondents who answered yes): Do you have a family doctor, a general practitioner or GP, or nurse practitioner that you see for regular check-ups, when you are sick and so on? Excludes: I don t have or computer don't know refused Measure source: Health Care Experience Survey (HCES). System level data source: Health Care Experience Survey (HCES), provided by Health Analytics Branch, Ministry of Health and Long-Term Care Practice level potential data source: Practice level patient experience survey Survey question: In the last 12 months, have you ed your [family doctor, nurse practitioner] with a medical question? yes no 40

43 Timing and frequency of data release doctor s office does not offer I don t have or computer don't know refused Quarterly (system level) Other relevant information Technical Working Group suggested texting could be another channel to ask medical question. However, as there were privacy concerns regarding this method, it was left for future consideration. *This rating is for the generic measure access to care by which included this specific measure along with other potential measures of this aspect of primary care performance. 41

44 Measurement priority Access to home visits for target populations Measure Name Patient reported access to home visits Level of reporting Availability Measure description System level Practice level System level: Measure currently reported in recommended form (province/lhin) Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients who report that it would have been better for their health if their regular family physician or nurse-practitioner had come to see them at home rather than them going to their office Rating* System level: 4.42 Practice level: 4.53 Numerator Number of respondents who reported that in the last 12 months, it would have been better for their health if their regular [family doctor/nurse practitioner) had come to their home to see them rather than them visiting their family doctor Respondents who have a regular family physician/nurse practitioner Measure source/data source/ data elements/ Base (respondents who answered yes): Do you have a family doctor, a general practitioner or GP, or nurse practitioner that you see for regular check-ups, when you are sick and so on? Excludes: don t know (includes never thought about it/would never happen) refuse Measure source: Health Care Experience Survey (HCES). System level data source: Health Care Experience Survey (HCES), provided by Health Analytics Branch, Ministry of Health and Long-Term Care Practice level potential data source: Practice level patient experience survey 42 Survey question: In the last 12 months, was there a time when it would have been better for

45 your health if [family doctor, nurse practitioner] had come to your home to see you rather than you going to your [family doctor, nurse practitioner] to see them? yes no don t know (includes never thought about it/would never happen) refused Timing and frequency of data release Quarterly (system level) *This rating is for the generic measure access to home visits by primary care physician which included this specific measure along with other potential measures of this aspect of primary care performance. 43

46 Measurement priority Measure Name Access to home visits for target populations Access to physician home visits for specific populations Level of reporting Availability System level Measure not currently available; new required for data collection, analysis and reporting (province/lhin) Measure description Percentage of primary care practices/organizations that offer physician home visits to: housebound patients adults with acute illnesses infants and young children with acute illnesses palliative-care patients patients recently discharged from hospital medically complex patients who are not housebound Rating* 4.89 Numerator Measure source/data source/ data elements/ Number of primary care practices that offer physician home visits to each of the following: housebound patients adults with acute illnesses infants and young children with acute illnesses palliative-care patients patients recently discharged from hospital medically complex patients who are not housebound Reported separately All respondents Measure source: New measure Potential data source: Provider reported or organization reported Proposed survey question: Does your practice offer physician home visits to the following patient groups: housebound patients adults with acute illnesses infants and young children with acute illnesses palliative care patients patients recently discharged from hospital medically complex patients who are not housebound Response options: yes 44

47 no don t know refused Other relevant information Timing and frequency of data release Measures Working Group- This measure should be analyzed for each target p through an organization survey. *This rating is for the generic measure access to home visits for specific populations which included this specific measure along with other potential measures of this aspect of primary care performance. 45

48 Measurement priority Access to home visits for target populations Measure Name Level of reporting Access to home visits for specific populations by other health care providers System level Availability Measure not currently available; new required for data collection, analysis and reporting (province/lhin) Measure description Percentage of primary care practices/organizations that offer home visits by other health professionals to: housebound patients adults with acute illnesses infants and young children with acute illnesses palliative-care patients patients recently discharged from hospital medically complex patients who are not housebound Rating* 4.47 Numerator Measure source/data source/ data elements/ Number of primary care practices that offer home visits by health professionals other than physicians to each of the following: housebound patients adults with acute illnesses infants and young children with acute illnesses palliative-care patients patients recently discharged from hospital medically complex patients who are not housebound Reported separately All respondents Measure source: New measure. Potential data source: Provider reported or organization reported Proposed survey question: Does your practice offer home visits to the following patient groups by other health professionals: housebound patients adults with acute illnesses Infants and young children with acute illnesses palliative care patients patients recently discharged from hospital medically complex patients who are not housebound 46

49 Timing and frequency of data release *This rating is for the generic measure access to home visits by other primary care providers which included this specific measure along with other potential measures of this aspect of primary care performance. 47

50 Appendix 7: Patient-Centredness Domain SMDs Measurement priority Measure name Respect for patients' and families' values, culture, needs and goals Primary care providers spending enough time with patients Level of reporting Availability Measure description Rating* System level: 4.53 Practice level: 4.84 Numerator System level Practice level System level: Measure currently reported in recommended form (province/lhin) Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients who report that their family physician, nurse practitioner or someone else in their office spends enough time with them Number of respondents who reported that their family doctor, nurse practitioner, or someone else in the practice often or always spends enough time with them Respondents who have a regular primary care provider Measure source/ data source / data elements/ Base (respondents who answer yes): Do you have a family doctor, a general practitioner or GP, or nurse practitioner that you see for regular check-ups, when you are sick and so on? Excludes: it depends on who they see and/or what they are there for don't know refused Measure source: Health Care Experience Survey (HCES); HQO practice level patient experience survey. System level data source: Health Care Experience Survey (HCES), provided by Health Analytics Branch, Ministry of Health and Long-Term Care Practice level potential data source: Practice level patient experience survey Survey question: When you see your (family doctor, nurse practitioner) or someone else in their office, how often do they spend enough time with you? 48 always often

51 Timing and frequency of data release sometimes rarely never it depends on who they see and/or what they are there for don't know refused System level: quarterly *This rating is for the generic measure adequate time with providers which included this specific measure along with other potential measures of this aspect of primary care performance. 49

52 Measurement priority Measure name Level of reporting Availability Measure description Rating* System level: 5.21 Practice level: 5.37 Numerator Respect for patients' and families' values, culture, needs and goals Patient involvement in decisions about their care and treatment System level Practice level System level: Measure currently reported but modified wording recommended (province/ LHIN) Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients who report their family physician, nurse practitioner or someone else in their office involves them as much as they want in decisions about their care or treatment Number of respondents who reported their (family doctor, nurse practitioner) or someone else in the office often or always involved them in the decisions about their care and treatment as much as they wanted Respondents who have a regular primary care provider Measure source/ data source / data elements/ Base (respondents who answer yes): Do you have a family doctor, a general practitioner or GP, or nurse practitioner that you see for regular check-ups, when you are sick and so on? Excludes: it depends on who they see and/or what they are there for no decisions required on care or treatment/not applicable don't know refused Measure source: Modified - Health Care Experience Survey (HCES), HQO practice level patient experience survey. System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey 50 Proposed system level survey question: When you see your (family doctor, nurse practitioner) or someone else in their office, how often do you (and your family caregiver when necessary) partner with them to develop a care plan or treatment plan together? always often

53 sometimes rarely never it depends on who they see and/or what they are there for no decisions required on care or treatment/not applicable don't know refused Original system level survey question: When you see your family doctor or someone else in their office, how often do they involve you as much as you want to be in decisions about your care and treatment? always often sometimes rarely never it depends on who they see and/or what they are there for no decisions required on care or treatment/not applicable don't know refused Proposed practice level survey question: When you see your (family doctor, nurse practitioner) or someone else in their office, how often do you (and your family caregiver when necessary) partner with them to develop a care plan or treatment plan together? always often sometimes rarely never Not applicable 51 Original practice level survey question: Please think of the main person you met with today. On a scale of poor to excellent, how would you rate the health care provider you saw on the following? Involved you to the extent that you want to be involved in decisions related to your care always often sometimes rarely never Not applicable

54 Timing and System level: quarterly frequency of data release *This rating is for the generic measure respect for patient s values and goals which included this specific measure along with other potential measures of this aspect of primary care performance. 52

55 Measurement priority Measure name Level of reporting Availability Measure description Respect for patients' and families' values, culture, needs and goals Patients comfort sharing concerns with their regular primary care provider System level Practice level System level: Measure not currently available but could be reported using existing (province/lhin) Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients who report being able to share their concerns with their family physician/nurse-practitioner Rating* System level: 5.21 Practice level: 5.37 Numerator Number of respondents who reported being able to mostly or completely share all their concerns with their family doctor or nurse practitioner System level: Respondents who visited their doctor or nurse [regular family doctor, nurse practitioner] over the past 12 months Measure source/ data source / data elements/ Base (respondents who answer yes to both questions): Do you have a family doctor, a general practitioner or GP, or nurse practitioner that you see for regular check-ups, when you are sick and so on? Have you visited your regular family doctor/nurse practitioner/gp over the past 12 months? Practice level: All respondents Measure source: Modified - CIHI- Patient experience survey System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey Proposed survey question: Are you able to share all your concerns with your family doctor or nurse practitioner? Yes, completely Yes, mostly Yes, a little No, not really 53

56 Timing and frequency of data release Original survey question: Thinking about the person you saw during your visit today... Did he or she really find out what your concerns were? Yes, completely Yes, mostly Yes, a little No, not really No, not at all *This rating is for the generic measure respect for patient s values and goals which included this specific measure along with other potential measures of this aspect of primary care performance. 54

57 Measurement priority Measure name Respect for patients' and families' values, culture, needs and goals Respectful treatment of patients by primary care providers Level of reporting Availability Measure description Rating* System level: 5.21 Practice level: 5.37 Numerator Measure source/ data source / data elements/ System level Practice level System level: Measure not currently available but could be reported using existing (province/lhin) Practice level: Measure not currently available ; new required for data collection, analysis and reporting Percentage of patients who report being treated with respect by their primary care providers Number of respondents who rated their primary care provider(s) as very good or excellent on treating them with respect All respondents Measure source: Modified - Practice Level Patient Experience Survey (HQO) System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey Original practice level survey question: Please think of the main person you met with today. On a scale of poor to excellent, how would you rate the healthcare provider you saw on the following? Treating you with respect Poor Fair Good Very Good Excellent Alternative survey question (for population or out-of-office practice level patient experience survey; reworded from HQO Practice Level Patient Experience Survey): On a scale of poor to excellent, how would you rate the people you see at your regular [family doctor's, nurse practitioner's] practice on the following 55 Treating you with respect Poor

58 Fair Good Very Good Excellent Timing and frequency of data release *This rating is for the generic measure respect for patient s values and goals which included this specific measure along with other potential measures of this aspect of primary care performance. Measurement priority 56 DEFINTION & SOURCE INFORMATION Measure name Level of reporting Availability Measure description Rating* System level: 5.21 Practice level: 5.37 Numerator Measure source/ data source / data Respect for patients' and families' values, culture, needs and goals Primary care providers sensitivity to patients cultural, ethnic and spiritual needs and values System level Practice level System level: Measure not currently available but could be reported using existing (province/lhin) Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients who report that their family physician/nurse-practitioner is sensitive to their cultural, ethnic and spiritual background and values Number of respondents who report that their primary care providers are often or always sensitive to their cultural, ethnic and spiritual background and values. Respondents who have a regular primary care provider Proposed base (respondents who answer yes): Do you have a family doctor, a general practitioner or GP, or nurse practitioner that you see for regular check-ups, when you are sick and so on? Excludes: don t know refused Measure source: Modified A Primary Health Care Evaluation System for Nova Scotia

59 elements/ System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey Proposed survey question: When you see your family doctor, nurse practitioner or someone else in their office, how often are they sensitive to your cultural, ethnic, and spiritual background and values? always often sometimes rarely never don t know refused Timing and frequency of data release Original survey question: Do Nova Scotians report that the services they receive are responsive to their cultural, racial, spiritual and other diverse needs? *This rating is for the generic measure respect for patient s values and goals which included this specific measure along with other potential measures of this aspect of primary care performance. 57

60 Measurement priority Measure name Level of reporting Availability Respect for patients' and families' values, culture, needs and goals Rating by patients with chronic conditions of discussion with their health care provider System level Practice level System level: Measure not currently available but could be reported using existing (province/lhin) Practice level: Measures not currently available ; new required for data collection, analysis and reporting Measure description Percentage of patients with chronic conditions who rate their discussion with their primary care provider as very good or excellent Rating* System level: 5.21 Practice level: 5.37 Numerator Number of respondents who rated their discussion with their health care provider(s) as very good or excellent in the context of their overall treatment plan Patients with at least one chronic condition who reported working out a treatment plan with their healthcare provider Measure source/ data source / data elements/ Base (Respondents answered yes to both): Have you ever been told by a doctor or other health provider that you have any of the following long-term health conditions? (Select all that apply). Have you and your health care provider(s) worked out a treatment plan together about to manage your chronic condition(s)? Measure source: Practice level Patient Experience Survey (HQO) System level potential data source: Population survey Practice level potential data source: Patient experience survey Original practice level survey question: How would you rate the healthcare provider(s) you consulted with today in discussing what you saw them about in the context of your overall treatment plan? Poor Fair Good Very Good Excellent Alternative survey question (for population or out-of-office 58

61 practice level patient experience survey; reworded from HQO Practice Level Patient Experience Survey): On a scale of poor to excellent, how would you rate the healthcare provider you see at your regular [family doctor's, nurse practitioner's] practice in discussing what you see them about in the context of your overall treatment plan Poor Fair Good Very Good Excellent Timing and frequency of data release *This rating is for the generic measure respect for patient s values and goals which included this specific measure along with other potential measures of this aspect of primary care performance. 59

62 Measurement priority Measure name Level of reporting Availability Respect for patients' and families' values, culture, needs and goals Primary care providers communicating with patients in a language they can understand System level Practice level System level: Measure not currently available but could be reported using existing (province/lhin) Practice level: Measure not currently available; new required for data collection, analysis and reporting (practice level) Measure description Percentage of patients who report that their family physician/ nurse-practitioner is able to communicate with them in a language they can understand Rating* System level: 4.53 Practice level: 4.68 Numerator Number of individuals who rated their family doctor or nurse practitioner as very good or excellent at being able to communicate in a language that they could understand (English, French, other) System level: Respondents who have a regular health care provider Measure source/ data source / data elements/ Base (respondents who answer yes): Do you have a family doctor, a general practitioner or GP, or nurse practitioner that you see for regular check-ups, when you are sick and so on? Measure source: Practice Level Patient Experience Survey (HQO) Practice level potential data source: Population survey Practice level potential data source: Practice level patient experience survey Original practice level survey question: Please think of the main person you met with today. On a scale of poor to excellent, how would you rate the healthcare provider you saw on the following? Being able to communicate in language that you could understand (English, French, other) Poor Fair Good Very Good 60

63 Excellent Alternative survey question (for population or out-of-office practice level patient experience survey; reworded from HQO Practice Level Patient Experience Survey): On a scale of poor to excellent, how would you rate your family doctor or nurse practitioner on their ability to communicate with you in a language that you could understand (English, French, other) Poor Fair Good Very Good Excellent Timing and frequency of data release *This rating is for the generic measure respect for Cultural appropriateness which included this specific measure along with other potential measures of this aspect of primary care performance. Measurement priority Measure name Level of reporting Availability Measure description Rating* 4.89 Process to obtain patient/client and caregiver input regarding health care services Processes to obtain input from patients and caregivers on planning and organizing primary care services System level Measure not currently available; new data collection required (province/lhin) Percentage of practices/organizations that report having processes in place to obtain input from patients and caregivers on the planning and organization of services DEFINTION & SOURCE INFORMATION Numerator Number of primary care practices/organizations who reported having processes (e.g., advisory committee, focus group, participation on decision-making bodies) to obtain input on planning and organizing services from: patients family caregivers Reported separately All respondents 61

64 Measure source/ data source / data elements/ Measure source: Modified - Family-Centred Care Self- Assessment Tool Potential data source: Organization reported Proposed survey question: Does your practice/organization have processes (e.g., advisory committee, focus group, participation on decision-making bodies) to obtain input on planning and organizing the services you provide, from: patients caregivers Timing and frequency of data release Original survey question: Does the care setting have a formal advisory committee for family and youth to provide input on policies and practices? *This rating is for the generic measure process to obtain patient/client and caregiver input regarding health care services which included this specific measure along with other potential measures of this aspect of primary care performance. 62

65 Measurement priority Respectful and understandable communication with patients Measure name Level of reporting Availability Measure description Patients informed about expected wait time in the office/clinic before being seen by their primary care provider Practice level Measure not currently available; new required for data collection, analysis and reporting required Percentage of patients who report that they were kept informed about how long they would need to wait for their appointment to start Rating 3.75 Numerator Measure source/ data source / data elements/ Timing and frequency of data release Number of respondents who reported that they were kept informed about how long they would need to wait for their appointment to start Number of respondents who visited their primary care provider in the past 12 months Base (respondents who answer yes): Have you visited your primary care provider in the past 12 months? Measure source: CAHPS- Clinician & Group Survey Potential data source: Practice level patient experience survey Survey question: During your most recent visit with this doctor/nurse practitioner, were you kept informed about how long you would need to wait for your appointment to start? Yes No 63

66 Measurement priority Measure name Respectful and understandable communication with patients Patients receiving enough information about new medications Level of reporting Availability Measure description Rating* System level: 5.21 Practice level: 5.47 Numerator Measure source/ data source / data elements/ System level Practice level System level: Measure not currently available but could be reported using existing (province/lhin) Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients prescribed new medicines who feel they were given enough information about their purpose, benefits and risks Number of respondents who reported often or always getting enough information from their health care provider about the purpose, benefits, and risks of newly prescribed medicines All respondents Measure source: Modified - The Picker Institute Europe Project Literature System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey Proposed survey question: When you were prescribed a new medicine were you and your family caregiver given enough information about its purpose, benefits and risks always often sometimes rarely never not applicable (have not been prescribed a new medicine recently) Timing and frequency of data release Original survey question: Percentage of primary care patients prescribed new medicines who felt they had been given enough information about their purpose. 64

67 The measures working group suggested that pharmacists also sometimes help patients understand the purpose, benefits and risks of medications but would not be captured in this measure. *This rating is for the generic measure Understandable communication with patients which included this specific measure along with other potential measures of this aspect of primary care performance. 65

68 Measurement priority Measure name Level of reporting Availability Measure description Rating* System level: 5.21 Practice level: 5.47 Respectful and understandable communication with patients Patients receiving enough information about procedures and treatments System level Practice level System level: Measure not currently available but could be reported using existing (province/lhin) Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients who feel they were given enough information about the purpose, benefits and risks of procedures and treatments Numerator Measure source/ data source / data elements/ Number of respondents who reported often or always getting enough information about a procedure or recommended treatment's purpose, benefits and risks from their family doctor /nurse practitioner All respondents Measure source: Modified - The Picker Institute Europe Project Literature System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey Proposed survey question: When your [family doctor, nurse practitioner] performed or ordered a procedure or started or recommended a treatment were you and your family caregiver(s) given enough information about its purpose, benefits and risks always often sometimes rarely never, no new treatment recommended Original Measure: Percentage of primary care patients prescribed new medicines who felt they had been given enough information about its 66

69 purpose. Timing and frequency of data release *This rating is for the generic measure Understandable communication with patients which included this specific measure along with other potential measures of this aspect of primary care performance. 67

70 Measurement priority Measure name Level of reporting Availability Measure description Respectful and understandable communication with patients Primary care providers explaining things in a way that is easy to understand System level Practice level System level: Measure currently reported in recommended form (province/lhin) Practice level: Measure not currently available; new required for data collection, analysis and reporting System level: Percentage of patients who report that their family physician, nurse practitioner or someone else in their office explains things in a way that is easy to understand Practice level: Percentage of patients who rate the main provider they saw as very good or excellent at explaining things in a way that is easy to understand Rating* System level: 5.21 Practice level: 5.47 Numerator System level: Number of respondents who reported often or always receiving explanations from their family doctor, nurse practitioner, or someone else in their office in a way that is easy to understand Practice level: Number of respondents who rated the health care provider they saw as excellent or very good at explaining things in a way that was easy to understand Respondents who have a regular primary care provider Base (respondents who answer yes): Do you have a family doctor, a general practitioner or GP, or nurse practitioner that you see for regular check-ups, when you are sick and so on? Excludes: it depends on who they see and/or what they are there for don't know refused 68

71 Measure source/ data source / data elements/ Measure source: Health Care Experience Survey (HCES); Practice level Patient Experience Survey (HQO) System level data source: Health Care Experience Survey (HCES), provided by Health Analytics Branch, Ministry of Health and Long-Term Care Practice level potential data source: Practice level patient experience survey System level survey question: When you see your family doctor, nurse practitioner or someone else in their office, how often do they explain things in a way that is easy to understand? always often sometimes rarely never it depends on who they see and/or what they are there for don't know refused Timing and frequency of data release Practice level survey question: Please think of the main person you met with today. On a scale of poor to excellent, how would you rate the doctor/healthcare provider you saw on the following? Explaining things in a way that is easy to understand Poor Fair Good Very Good Excellent System level: quarterly *This rating is for the generic measure Understandable communication with patients which included this specific measure along with other potential measures of this aspect of primary care performance. 69

72 Measurement priority 70 Measure name Level of reporting Availability Respectful and understandable communication with patients Primary care providers giving clear instructions about symptoms to watch for System level Practice level System level: Measure not currently available but could be reported using existing (province/lhin) Practice level: Measure not currently available; new required for data collection, analysis and reporting Measure description Percentage of patients who report getting clear instructions from their family physician/nurse-practitioner or other person in their office about symptoms to watch for and when to seek further care or treatment Rating* System level: 5.21 Practice level: 5.47 Numerator Number of respondents who reported mostly or completely getting clear instructions about symptoms to watch for and when to seek further care or treatment from their family doctor, nurse practitioner or someone else in their office they saw Measure source/ data source / data elements/ All respondents Measure source: Modified - CIHI- Patient experience survey System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey Proposed survey question: When you see your family doctor, nurse practitioner or someone else in their office, do they give you or your family/caregiver clear instructions about symptoms to watch for and when to seek further care or treatment? Yes, completely Yes, mostly Yes, a little No, not really No, not at all Original survey question: Thinking about the person you saw during your visit today... Did he or she give you clear instructions about symptoms to watch for and when to seek further care or treatment? Yes, completely Yes, mostly

73 Yes, a little No, not really No, not at all Timing and frequency of data release *This rating is for the generic measure Understandable communication with patients which included this specific measure along with other potential measures of this aspect of primary care performance. 71

74 Measurement priority Measure name Respectful and understandable communication with patients Patients who were asked about their preferred treatment choices Level of reporting Availability Measure description Rating* Numerator Measure source/ data source / data elements/ System level Practice level System level: Measure not currently available but could be reported using existing (province/lhin) Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients who worked out a treatment plan together with their family physician/nurse-practitioner over the past 12 months who report that their family physician/nurse practitioner asked what treatment choices they would prefer System level: Practice level: Number of respondents who reported being asked by their family doctor or nurse practitioner what treatment they preferred when there were treatment choices over the past 12 months All respondents Measure source: Modified - CIHI- Patient experience survey System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey Proposed survey question: Over the past 12 months, when there were treatment choices, did your family doctor or nurse practitioner ask you what treatment you would prefer? No Yes, sometimes Yes, often I haven t received any treatment in the past 12 months Original Survey question: When there were treatment choices, did your doctor ask you what treatment you would prefer? Timing and frequency of data release No Yes, sometimes Yes, often I haven t received any treatment in the past 12 months 72

75 *This measure does not have ratings as it was added after the rating process.measurement priority Respectful and understandable communication with patients Measure name Level of reporting Availability Measure description Rating* System level: 5.21 Practice level: 5.47 Numerator Primary care providers asking about feasibility of recommended treatment plans System level Practice level System level: Measure not currently available but could be reported using existing (province/lhin) Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients who worked out a treatment plan together with their family physician/nurse-practitioner over the past 12 months who report that their family physician/nurse-practitioner asked whether they could do the recommended treatment plan Number of respondents who reported their health care provider (family doctor, nurse practitioner) sometimes or often asked whether they could do the recommended treatment plan Respondents who worked out a treatment plan together with their (family doctor, nurse practitioner) over the past 12 months. Measure source/ data source / data elements/ Proposed base (respondents who answered yes): Did you and your family doctor or nurse practitioner work out a treatment plan together over the past 12 months? Excludes: I haven t received any treatment in the past 12 months Measure source: Modified - CIHI- Patient experience survey System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey Proposed survey question: Did your [family doctor, nurse practitioner] ask whether you or your family/caregiver felt you could do the recommended treatment plan? No Yes, sometimes Yes, often I haven t received any treatment in the past 12 months 73

76 Timing and frequency of data release Original survey question: Respondents who had worked out a treatment plan together over the past 12 months. Did your doctor ask whether you felt you could do the recommended treatment plan? No Yes, sometimes Yes, often I haven t received any treatment in the past 12 months *This rating is for the generic measure Understandable communication with patients which included this specific measure along with other potential measures of this aspect of primary care performance. 74

77 Measurement priority Measure name Level of reporting Availability Respectful and understandable communication with patients Patients comfort discussing personal problems with their primary care provider System level Practice level System level: Measure not currently available but could be reported using existing (province/ LHIN) Practice level: Measure not currently available; new required for data collection, analysis and reporting Measure description Percentage of patients who report that they feel comfortable talking with their family physician/nurse-practitioner about personal problems related to their health condition Rating* System level: 4.79 Practice level: 5.05 Numerator Number of respondents who reported feeling very or completely comfortable talking with their family doctor or nurse practitioner about personal problems related to their health condition Measure source/ data source / data elements/ Timing and frequency of data release All respondents Measure source: CIHI- Patient experience survey System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey Survey question: How comfortable do you feel talking with this person [your family doctor or nurse practitioner] about personal problems related to your health condition? Hardly comfortable at all Only somewhat comfortable Moderately comfortable Very comfortable Completely comfortable *This rating is for the generic measure Respectful communication with patients which included this specific measure along with other potential measures of this aspect of primary care performance. 75

78 Measurement priority Measure name Respectful and understandable communication with patients Opportunity to ask questions about recommended treatment Level of reporting Availability Measure description Rating* System level: 4.79 Practice level: 5.05 Numerator System level Practice level System level: Measure currently available, but modified wording recommended Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients who report that their family physician/ nurse-practitioner or someone else in their office gives them an opportunity to ask questions about recommended treatment Number of respondents who reported often or always getting an opportunity to ask their family doctor, nurse practitioner or someone else in their office questions about recommended treatment Respondents who have a regular primary care provider 76 Measure source/ data source / data elements/ Base (respondents who answer yes): Do you have a family doctor, a general practitioner or GP, family physician, nurse practitioner, or family medicine resident that you see for regular check-ups, when you are sick and so on? Excludes: it depends on who they see and/or what they are there for not using/on any treatments/not applicable don t know refused Measure source: Modified- Health Care Experience Survey (HCES); HQO practice level patient experience survey System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey Proposed system level survey question: When you see your family doctor, nurse practitioner or someone else in their office, how often do they work together with you and if necessary your family caregiver(s) to develop a treatment plan and share understanding of how it will be implemented? always often sometimes rarely

79 never it depends on who they see and/or what they are there for not using/on any treatments/not applicable don't know refused Proposed practice level survey question: Now, we d like you to think more broadly for a minute about your experience with this office over the past year or so. From this perspective... When you see your family doctor or someone else in their office how often do they work together with you and if necessary your family caregiver(s) to develop a treatment plan and share understanding how it will be implemented? Never Rarely Sometimes Often Always Original system level survey question: When you see your [fill fd_type] or someone else in their office, how often do they give you an opportunity to ask questions about recommended treatment? always often sometimes rarely never it depends on who they see and/or what they are there for not using/on any treatments/not applicable don't know refused Original practice level survey question: Now, we d like you to think more broadly for a minute about your experience with this office over the past year or so. From this perspective... When you see your doctor or nurse practitioner, how often do they or someone else in the office give you an opportunity to ask questions about recommended treatment? Never Rarely Sometimes Often Always - Not Applicable 77 Timing and System level: quarterly

80 frequency of data release *This rating is for the generic measure Respectful communication with patients which included this specific measure along with other potential measures of this aspect of primary care performance. 78

81 Measurement priority Measure name Respectful and understandable communication with patients Courtesy of primary care reception staff Level of reporting Availability Measure description System level Practice level System level: Measure not currently available but could be reported using existing (province/ LHIN) Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients who rate the courtesy of reception staff at the practice they attend as very good or excellent Rating* System level: 5.21 Practice level: 5.37 Numerator Number of respondents who rated the courtesy of reception staff at their primary care provider s office as very good or excellent Measure source/ data source / data elements/ Timing and frequency of data release All respondents Measure source: Practice Level Patient Experience Survey (HQO) System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey Survey question: On a scale of poor to excellent, how would you rate the courtesy of the reception staff in your [family doctor's/nurse practitioner's] office? Poor Fair Good Very Good Excellent *This rating is for the generic measure Respect for patient s values and goals which included this specific measure along with other potential measures of this aspect of primary care performance. 79

82 Measurement priority Measure name Coordination of care within the primary care setting Mechanisms to support collaboration in primary care teams MEASURE DESCRIPTION Level of reporting Availability Measure description System level System level: Measure not currently available but could be reported using existing (province/ LHIN) Percentage of primary care practices/organizations that report having mechanisms in place to support collaboration Rating* System level: 5.05 Numerator Number of primary care teams/organizations who reported having any mechanisms to support collaboration: Regular team meetings to discuss practice and patient care issues Case conferences Other (please specify) All respondents Measure source/ data Measure source: Modified - A Primary Health Care Evaluation source / data for Nova Scotia elements/ Potential data source: Population survey Proposed survey question: Which of the following mechanisms does your primary care practice/organization have to support collaboration: Regular team meetings to discuss practice and patient care issues Case conferences Other (please specify) Original Measure: Percentage of PHC teams/organizations that have mechanisms to support collaboration Regular Team meetings, Joint goal setting, Shared vision. Timing and frequency of data release *This rating is for the generic measure Coordination of care within the primary care setting which included this specific measure along with other potential measures of this aspect of primary care performance. 80

83 Measurement priority Measure name Coordination of care within the primary care setting Patients ratings of primary care teamwork MEASURE DESCRIPTION Level of reporting Practice level Availability Practice level: Measure not currently available; new required for data collection, analysis and reporting Measure description Percentage of patients who rate their primary care providers as very good/excellent at working together as a team to coordinate the patient s care Rating* Practice level: 5.37 Numerator Measure source/ data source / data elements/ Number of respondents who rated their health care providers as very good or excellent at working as a team amongst themselves to arrange/coordinate the respondents care. Respondents who saw more than one healthcare professional at this clinic/office over the last 12 months Measure source: Practice Level Patient Experience Survey (HQO) Potential data source: Practice level patient experience survey Survey question: You indicated that you have seen more than one healthcare provider at this office/clinic over the past year or so. Thinking of these people as a group, on a scale of poor to excellent, how would you rate their performance on the following? Working together as a team in terms of doing an effective job in arranging/coordinating your care amongst themselves Poor Fair Good Very Good Excellent Timing and frequency of data release *This rating is for the generic measure Coordination of care within the primary care setting which included this specific measure along with other potential measures of this aspect of primary care performance. 81

84 Measurement priority Measure name Level of reporting Process for addressing suggestions/complaints Processes to obtain suggestions and address complaints from patients and families/caregivers System level Availability System Level: Measure not currently available; new required for data collection, analysis and reporting (province/lhin) Measure description Percentage of primary care practices/organizations that report having processes in place to obtain suggestions and address complaints from patients and families/caregivers Rating* System level: 4.74 Numerator Number of primary care practices/organizations that report any of the following processes for regularly obtaining suggestions and addressing complaints from patients and families/ caregivers Measure source/ data source / data elements/ Timing and frequency of data release Patient survey Caregiver survey Patient focus group Caregiver focus group Patient/caregiver advisory committee Suggestion/ complaint box All respondents Measure source: New measure Potential data source: Provider reported or organization reported Survey question: Does your practice/organization use any of the following processes regularly to obtain suggestions and address complaints from patients and families/caregivers? Patient survey Caregiver survey Patient focus group Caregiver focus group Patient/Caregiver advisory committee Suggestion/ complaint box *This rating is for the generic measure Process for addressing suggestions/complaints which included this specific measure along with other potential measures of this aspect of primary care performance. 82

85 Appendix 8: Integration Domain SMDs Measurement priority Information sharing across the continuum of care including patients and family caregivers Measure name Level of reporting System level Availability Measure description Rating 5.13 Use of two-way electronic communication by primary care practices/organizations Measure not currently available; new required for data collection, analysis and reporting Percentage of practices that have two-way electronic communication linkages (beyond fax and telephone) with other health care organizations Numerator Number of primary care practices/organizations who reported twoway electronic communication linkages (beyond fax and telephone) with other health care organizations (e.g. hospitals, community mental health agencies, long term care facilities, public health) Measure source/ data source / data elements/ Timing and frequency of data release Number of primary care practice/organization respondents providing patient care Measure source: Pan - Canadian Primary Health Care Indicator Project (2006): CIHI Potential data source: Provider or organization reported Proposed survey question: Do you currently have two-way electronic communication linkages (beyond fax and telephone) with other health care organizations (e.g. hospitals, community mental health agencies, long term care facilities, public health): - Yes - No - Don t know - Decline to answer 83

86 *Two-way communications is when information is sent and received electronically Measurement priority Measure Name Information sharing across the continuum of care including patients and family caregivers Test results available at scheduled appointments Level of reporting System level Availability Measure description Practice level System level: Measure currently reported in recommended form (Province /LHIN) Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients who report that, in the last 12 months, when receiving care for a medical problem, there was a time when test results were not available at the time of a scheduled appointment with their family physician 84 Rating System level: 4.47 Practice level: 4.80 Numerator Number of respondents in the denominator who reported that there was a time when test results were not available at the time of a scheduled appointment with their family doctor Measure source/ data source / data elements/ Number of respondents who have a health care provider or family doctor Base (respondents who answered yes): Do you have a family doctor, a general practitioner or GP, or nurse practitioner that you see for regular check-ups, when you are sick and so on? Excludes: did not receive care for medical problem/no tests in last 12 months not applicable Measure source: Health Care Experience Survey (HCES) System level data source: HCES provided by Health Analytics Branch, Ministry of Health and Long-Term Care

87 Practice level potential data source: Practice level patient experience survey Survey question: In the last 12 months, when receiving care for a medical problem, was there ever a time when test results were not available at the time of a scheduled appointment with your [family doctor, nurse practitioner]? Timing and frequency of data release Yes No did not receive care for medical problem/no tests in last 12 months/not applicable don t know refused System level: quarterly 85

88 Measurement priority Measure name Information sharing across the continuum of care including patients and family caregivers Family doctor/nurse practitioner up-to-date on specialist care Level of reporting System level Practice level Availability Measure description System level: Measure currently reported in recommended form (province/lhin) Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients who report that their family physician/nurse practitioner was informed and up-to-date about the care they received from specialists Rating System level: 4.27 Practice level: 4.27 Numerator Number of respondents who had seen a specialist who reported that their family doctor/nurse practitioner was informed and up-todate about the care they received from specialists Measure source/ data source / data elements/ Respondents who were advised by their family doctor/nurse practitioner to see a specialist in the past 12 months. Base (respondents who answered yes): In the past 12 months, have you been advised by your family doctor, nurse practitioner] to see a specialist? Excludes: did not see family doctor/nurse practitioner since seeing specialists Measure source: Health Care Experience Survey (HCES) System level data source: HCES provided by Health Analytics Branch, Ministry of Health and Long-Term Care Practice level potential data source: Practice level patient experience survey Survey question: After you saw the specialist, did your [family doctor, nurse practitioner] seem informed and up-to-date about the care you got from the specialist? 86 yes

89 no did not see [family doctor, nurse practitioner] since seeing specialist [excluded] Timing and frequency of data release don't know refused System level: quarterly 87

90 Measurement priority Measure name Information sharing across the continuum of care including patients and family caregivers Family doctor/nurse practitioner up-to-date on hospital care Level of reporting System level Practice level Availability System level: Measure currently reported in recommended form (Province/LHIN) Measure description Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients who report that their family physician/nurse practitioner was informed and up-to-date about the care they received in the hospital Rating System level: 3.93 Practice level: 4.07 Numerator Number of respondents who reported that their [family doctor/nurse practitioner] was informed and up-to-date about the care they received while in the hospital. Measure source/ data source / data elements/ Number of respondents who have a regular doctor and were hospitalized overnight in the last 12 months. Base (respondents who answered yes to both questions): Do you have a family doctor, a general practitioner or GP, or nurse practitioner that you see for regular check-ups, when you are sick and so on? In the last 12 months, have you been hospitalized overnight? Excludes: I did not see a/my doctor/gp after leaving the hospital did not receive care for medical problem/ no tests in the last 12 months/ not applicable Not sure Decline to answer Measure source: Health Care Experience Survey (HCES) System level data source: HCES provided by Health Analytics Branch, Ministry of Health and Long-Term Care Practice level potential data source: Practice level patient experience survey 88

91 Survey question: After you were discharged from hospital, did your [family doctor, nurse practitioner] seem informed and up-to-date about the care you received in the hospital? yes no have not seen [family doctor, nurse practitioner] since discharged from hospital did not receive care for medical problem/ no tests in the last 12 months/ not applicable don t know refused Timing and frequency of data release System level: quarterly 89

92 Measurement priority Measure name Information sharing across the continuum of care including patients and family caregivers Primary Care providers receipt of information from specialists Level of reporting System level Availability Measure description Measure currently reported in recommended form (Province/Other provinces/canada/international) Percentage of primary care physicians who report that they receive the following information after their patients visits to specialists: A report back from the specialist with all relevant health information Information about changes the specialist has made to the patient s medication or care plan Information that is timely and available when needed Rating 5.07 Numerator Number of providers who reported always or often receiving: 90 Measure source/data source / data elements/infrastr ucture A report back from the specialist with all relevant health information Information about changes the specialist has made to the patient s medication or care plan Information that is timely and available when needed Reported separately All respondents Excludes: Not sure Decline to answer Measure source: Commonwealth Fund International Health Policy Survey 2012 (Primary Care Doctors) System level data source: Commonwealth Fund International Health Policy Survey 2012 (Primary Care Doctors) Survey question: When your patient has been seen by a specialist, how often do you receive the following? A report back from the specialist with all relevant health information Information about changes the specialist has made to the patient s medication or care plan Information that is timely and available when needed

93 Timing and frequency of data release (response options) Always Often Sometimes Rarely Never Not sure Decline to answer Every three years (the latest release date 2012) 91

94 Measurement priority Information sharing across the continuum of care including patients and family caregivers Measure name Level of reporting System level Availability Measure description Primary Care providers receipt of information from the emergency department and hospital Measure currently reported in recommended form (Province/Other provinces/canada/international) Percentage of primary care physicians who report that they receive notification that their patient: Has been seen in the emergency department Is being discharged from the hospital Rating 5.07 Numerator Number of providers who reported always or often receiving: Notification your patient has been seen in the emergency department Notification your patient is being discharged from the hospital Reported separately Measure source/ data source / data elements/ All respondents Excludes: Not sure Decline to answer Measure source: Commonwealth Fund International Health Policy Survey 2012 (Primary Care Doctors) System level data source: Commonwealth Fund International Health Policy Survey 2012 (Primary Care Doctors) Survey question: When your patients go to the emergency department or hospital, how often do you receive? Notification your patient has been seen in the emergency department Notification your patient is being discharged from the hospital 92 (response options) Always Often Sometimes Rarely Never

95 Not sure Decline to answer Timing and frequency of data release Every three years (the latest release date 2012) NA 93

96 Measurement priority Measure name Information sharing across the continuum of care including patients and family caregivers Provider-reported wait time for receipt of needed information after patient hospital discharge Level of reporting System level Availability Measure description Measure currently reported in recommended form (Province/Other provinces/canada/international) Percentage of primary care physicians who report that on average they receive the needed information after their patients discharge from hospital within: <24 hours hours 2-4 days 5-14 days days >30 days Rarely or never 94 Rating 5.20 Numerator Measure source/ data source / data elements/ Wait time for receipt of information among providers who reported that they received the needed information after their patients discharge from hospital. <24 hours hours 2-4 days 5-14 days days >30 days Rarely or never This measure will be reported as the percent of providers receiving information within some threshold to be determined. All respondents Excludes: Not sure Decline to answer Measure source: Commonwealth Fund International Health Policy Survey 2012 (Primary Care Doctors) System level data source: Commonwealth Fund International Health Policy Survey 2012 (Primary Care Doctors)

97 Survey question: After your patient has been discharged from the hospital, on average, how long does it take before you receive the information you need to continue managing the patient, including recommended follow-up care? <24 hours hours 2-4 days 5-14 days days >30 days Rarely or never Not sure Decline to answer Timing and frequency of data release Every three years (the latest release date 2012) 95

98 Measurement priority Measure name Information sharing across the continuum of care including patients and family caregivers Patients receiving timely notification of abnormal test results Level of reporting System level Availability Measure description Practice level System level: Measure currently reported in recommended form (Province/Other provinces/canada/international) Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients who report delays in being notified about abnormal test results in the past two years Rating System level: 4.60 Practice level: 4.73 Numerator Number of respondents who reported they had experienced delays in being notified about abnormal test results in the past 2 years. Number of respondents who had medical tests in the past 2 years. Base (respondents who answered yes): Measure source/data source / data elements/infrastr ucture Have you had any blood tests, x-rays, or any other medical tests in the past 2 years? Excludes: Not sure Decline to answer Measure source: Commonwealth Fund International Health Policy Survey 2013 System level data source: Commonwealth Fund International Health Policy Survey 2013 Practice level potential data source: Practice level patient experience survey Survey question: In the past 2 years, have you experienced delays in being notified about abnormal test results? Yes 96

99 No Not sure Decline to answer Timing and frequency of data release System level: Every three years (the latest release date 2013) Measurement priority Care coordination with other health and community care providers and services Measure Name Level of reporting System level Availability Measure description Rating 5.08 Providers able to co-ordinate care with service organizations in the community for their most complex patients Measure not currently available; new required for data collection, analysis and reporting Percentage of primary care providers who report being able to coordinate care with service organizations in the community in planning and providing care for their most complex patients Numerator Measure source/data source / data elements/infrastr ucture Number of providers in the denominator who reported that for their most complex patients they are able always, almost always or usually to co-ordinate care with service organizations in the community in planning and providing care for them. All respondents Measure Source: QualicoPC - Family Physician Survey and Provider Survey from the Practice-Based Set of PHC Survey Tools CIHI System level potential data source: Organization or provider reported Survey question: To what extent are you able to co-ordinate care with service organizations in the community in planning and providing care for your most complex patients (e.g. patients with multiple chronic conditions or significant social issues impacting their health)? Unable to Occasionally unable to Sometimes able to 97

100 Usually able to Always or almost always able to Timing and frequency of data release 98

101 Measurement priority Measure name Care coordination with other health and community care providers and services Care coordination by primary care providers Level of reporting System level Availability Measure description Measure currently reported but modified wording recommended (Province/Other provinces/canada/international) Percentage of primary care physicians who report that they or someone else in the practice provides care in the following ways: Managing and coordinating care for their patients after hospital discharge Coordinating care with social services or other community providers Rating 4.30 Numerator Number of providers who reported that they or someone else in the practice provide care in the following ways: Measure source/ data source / data elements/ Managing and coordinating care for their patients after hospital discharge Coordinating care with social services or other community providers Reported separately All respondents Measure source: Modified- Commonwealth Fund International Health Policy Survey 2012 (Primary Care Doctors) System level potential data source: Provider/organization reported Proposed survey question: Does anyone in your practice help manage or provide care in any of the following ways? Help manage and coordinate care after hospital discharge Coordinate care with social services or other community providers (response options) Yes No 99

102 Not sure Decline to answer Original survey questions: (In the original survey, there were two questions asked one asked to non-doctor FTEs and one asked to the doctor) Base: Respondents who have one or more non-doctor FTE Health Care Provider Do any of these providers (nurses, therapists or other clinicians) help manage or provide care in any of the following ways? Help manage and coordinate care after hospital discharge Coordinate care with social services or other community providers (response options) Yes No Not sure Decline to answer Base: All respondents Do you help manage or provide care in any of the following ways? Timing and frequency of data release Help manage and coordinate care after hospital discharge Coordinate care with social services or other community providers (response options) Yes No Not sure Decline to answer Every three years (the latest release date 2012) 100

103 Measurement priority Measure Name Care coordination with other health and community care providers and services Primary care providers help to book appointments or coordinate specialist care Level of reporting System level Availability Measure description Practice level System level: Measure currently reported in recommended form (Province/LHIN) Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients who report that their family physician or someone in their office helped them book appointments or coordinate the care they received from specialists over the past 12 months Rating System level: 3.92 Practice level: 4.17 Numerator Number of respondents who reported that their family doctor or someone in their office helped them book appointments or coordinate the care they received from specialists over the past 12 months Respondents who were advised by their family doctor to see a specialist in the past 12 months. Base (respondents who answered yes): In the past 12 months, have you been advised by your [family doctor, nurse practitioner] to see a specialist? Excludes: never had the need for this as not seeing specialists don't know refused 101

104 Measure source/ data source / data elements/ Measure source: Health Care Experience Survey (HCES) System level data source: HCES provided by Health Analytics Branch, Ministry of Health and Long-Term Care Practice level potential data source: Practice level patient experience survey Survey Question: The last time you saw a specialist, did your [family doctor, nurse practitioner] or someone in their office book an appointment for you or coordinate the care you received from the specialist? yes no never had the need for this as not seeing specialists Timing and frequency of data release don't know refused System level: Quarterly 102

105 Measurement priority Measure name Care coordination with other health and community care providers and services Coordination of care received from community based health or social services Level of reporting System level Practice level Availability Measure description System level: Measure not currently available; new required for data collection, analysis and reporting (Province/Other provinces/canada/international) Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients who report that their family physician, nurse practitioner or someone in their office helped them arrange or coordinate the care they received from community-based health or social services over the past 12 months 103 Rating System level: 3.67 Practice level: 3.50 Numerator Number of respondents who reported that their family doctor/nurse practitioner or someone in their office helped them arrange or coordinate the care they received from community based health or social services over the past 12 months Measure source/data source / data Respondents who have a family doctor. Base (respondents who answered yes) Is there one doctor you usually go to for your medical care? Yes have a regular doctor/gp Yes, but have more than one regular doctor/gp Is there one doctor s group, health center, or clinic you usually go to for most of your medical care? Excludes: never had the need to use community based health and social services in the last 12 months don't know refused Measure Source: Modified - Commonwealth Fund International Health Policy Survey 2013

106 elements/infrastr ucture System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey Proposed survey question: In the past 12 months, did your family doctor or someone in their office help arrange or coordinate the care you received from community based health or social services? yes no never had the need to use community based health and social services in the last 12 months don't know refused Original survey question: How often does your regular doctor or someone in your doctor's practice help coordinate or arrange the care you receive from other doctors and places? Always Often Sometimes Rarely or never Never see other doctors/places or needed coordination Not sure Decline to answer Coordination could include helping you get appointments, following-up to make sure you get recommended care, and making sure other doctors have important information Timing and frequency of data release 104

107 Measurement priority Measure name Care coordination with other health and community care providers and services Patients rating of care coordination for chronic conditions Level of reporting System level Practice level Availability Measure description System level: Measure not currently available; new required for data collection, analysis and reporting Practice level: Measure not currently available required for data collection, analysis and reporting Percentage of patients with chronic conditions who rate their family physician/nurse practitioner as very good or excellent in helping to coordinate their care and treatment across other parts of the health care system and with other health care providers Rating System level: 4.25 Practice level: 4.50 Numerator Number of respondents with chronic conditions who rated their family doctor/ nurse practitioner as very good or excellent in helping arrange/co-ordinate their care/treatment across other parts of the healthcare system/with other healthcare professionals to deal with their chronic illness Measure source/data source / data elements/infrastr ucture Number of respondents with chronic conditions Base (respondents who answer yes): Have you ever been told by a doctor or other health provider that you have any of the following long-term conditions? Measure source: Practice Level Patient Experience Survey (HQO) System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey (HQO) Original practice level survey question: How would you rate the doctor/healthcare provider you saw at this visit in helping arrange/co-ordinate your care/treatment across other parts of the healthcare system/with other healthcare professionals to deal with your chronic illness(es)? 105

108 Poor Fair Good Very Good Excellent Alternative survey question (for population or out-of-office practice level patient experience survey; reworded from HQO Practice Level Patient Experience Survey): How would you rate your family doctor/ nurse practitioner in helping arrange/co-ordinate your care/treatment across other parts of the healthcare system/with other healthcare professionals to deal with your chronic condition? Poor Fair Good Very Good Excellent NA Timing and frequency of data release 106

109 Measurement priority Measure Name Time to referred appointment with medical/surgical specialist or other specialized services Wait time to medical/surgical specialist appointment Level of reporting System level Availability Measure description Practice level System level: Measure currently reported but modified wording recommended (Province/LHIN) Practice level: Measure not currently available; new required for data collection, analysis and reporting Self-reported wait times for patients who were advised to see a specialist Rating System level: 4.50 Practice level: 4.17 Numerator Wait time for an appointment among respondents who reported waiting for a specialist appointment Days Weeks Months Years This measure will be reported as some measure of the distribution of the wait time (e.g., mean, median, percentile) Respondents who were advised to see é referred to a medical/ surgical specialist or other specialized health service Base (respondents who answered yes): In the past 12 months, have you been advised by your family doctor/nurse practitioner to see/ referred to a medical/surgical specialist or other specialized health services? Excludes: Never got an appointment/still waiting/etc. don't know refused 107 Measure source/ data source / data elements/ Measure source: Modified- Health Care Experience Survey (HCES)

110 System level potential data source: Population Survey Practice level potential data source: Practice level patient experience survey Proposed survey question: After you were advised to see / referred to a medical/surgical specialist or other specialized health services, how many days, weeks or months did you have to wait for an appointment? Days: Weeks: Months: Years: Never got an appointment/still waiting/etc. don't know refused Original survey question: After you were advised to see a specialist, how many days, weeks or months did you have to wait for an appointment? Days: Weeks: Months: Years: never got an appointment/still waiting/etc. don't know refused Timing and frequency of data release System level: Quarterly Technical Working Group recommendation: Data from this measure will help to gene Should be used to identify a baseline and establish benchmarks in future. 108

111 Measurement priority Measure Name Hospital admissions and readmissions 30-day and 1-year hospital readmission rate Level of reporting System level Practice level Availability Measure description System level: Measure currently reported in recommended form (Province/LHIN) Practice level: Measure currently reported in recommended form (practice) Percentage of patients who were re-admitted to a hospital following their initial hospitalization within: 30 days of discharge One year of discharge Rating System level: 5.58 Practice level: 4.92 Numerator The number of non-elective hospital readmissions following any hospitalization (including elective hospitalizations) within 30 days of discharge within one year of discharge Note: Hospital readmission is readmission to any acute care hospital in the province for any condition, including a different condition than the reason for their original hospital admission System level: Patients who are in the Registered Persons Database and Alive at index (born and not dead) Had contact with the health care system within the previous 7 years Ontario resident Eligible for OHIP at index date Practice level: Number of rostered and virtually rostered patients discharged from hospital. Rostered patients: 109

112 All people with status_cape =10, 11, 12, 15 (they are rostered or reside in LTC) Cape eligibility overlaps index date Virtually rostered: All visits to spec= 00, 05, 26 GP, (Comm Med, Pead) for the 7 year period preceding the index date for the following feecodes- A001, A003, A007,A903, E075, G212, G271, G372, G373, G365, G538, G539, G590, G591, K005, K013, K017, P004, A261, K267, K269 core Primary Care codes (patient is assigned to the highest billing physician) Measure source/ data source / data elements/ Measure source: Primary Care Practice Report System level data source: Primary Care Practice Report, provided by ICES using Discharge Abstract Database (DAD), Client Agency Patient Enrollment (CAPE, Ontario Health Insurance Plan (OHIP) Practice level data source: Primary Care Practice Report, provided by ICES using Discharge Abstract Database (DAD), Client Agency Patient Enrollment (CAPE, Ontario Health Insurance Plan (OHIP) Timing and frequency of data release Practice level: Potential for bi-annual reporting System level: Potential for bi-annual reporting 110

113 Measurement priority Measure Name Hospital admissions and readmissions Rate of hospital admissions for specific chronic conditions Level of reporting System level Availability Measure description Practice level System level: Measure currently reported in recommended form (Province/LHIN) Practice level: Measure currently reported in recommended form (practice) Rate of hospital admissions for specific chronic conditions per 1,000 population, by condition (asthma, chronic obstructive pulmonary disease, congestive heart failure, diabetes) and combined Rating System level: 4.83 Practice level: 4.17 Numerator Number of patients discharged from acute care hospitals over the past 12 months for the following conditions: asthma (ICD10- J45) congestive heart failure (CHF) (ICD10-I500, J81) chronic obstructive pulmonary disease (COPD) (ICD-10- J41, J42, J43, J44, J47) Diabetes (ICD10- E10.1, E10.6, E10.7, E10.9, E11.0, E11.1, E11.6, E11.7, E11.9, E13.0, E13.1, E13.6, E13.7, E13.9, E14.0, E14.1, E14.6, E14.7, E14.9) all four combined The admissions for the conditions are selected by looking for condition specific ICD-10 diagnosis in the previous year excluding in-hospital complications (i.e. Diagnosis type M and 2) System level: Patients who are in the Registered Persons Database and Alive at index (born and not dead) Had contact with the health care system within the previous 7 years Ontario resident Eligible for OHIP at index date 111

114 Practice level: Rostered or virtually rostered population Rostered patients: All people with status_cape =10, 11, 12, 15 (they are rostered or reside in LTC) Cape eligibility overlaps index date Virtually rostered: All visits to spec= 00, 05, 26 GP, (Comm Med, Pead) for the 2 year period preceding the index date for the following feecodes- A001, A003, A007,A903, E075, G212, G271, G372, G373, G365, G538, G539, G590, G591, K005, K013, K017, P004, A261, K267, K269 core Primary Care codes (patient is assigned to the highest billing physician) Measure source/ data source / data elements/ Measure source: Primary Care Practice Report Practice level data source: Primary Care Practice Report, provided by ICES using Discharge Abstract Database (DAD), Client Agency Patient Enrollment (CAPE, Ontario Health Insurance Plan (OHIP) System level data source: Primary Care Practice Report, provided by ICES using Discharge Abstract Database (DAD), Client Agency Patient Enrollment (CAPE, Ontario Health Insurance Plan (OHIP) Timing and frequency of data release Practice level: Potential for bi-annual reporting System level: Potential for bi-annual reporting 112

115 Measurement priority Measure name Follow-up with regular primary care provider post hospital discharge 7-day post hospital discharge follow-up rate for selected conditions Level of reporting Availability Measure description System level Practice level System level: Measure currently available in recommended form (Province/LHIN) Practice level: Measure currently available in recommended form (Note: measure is available only for Patient Enrolment Models, CHCs, AHACs and NPLCs) Percentage of patients who see their primary care provider within seven days after discharge from hospital for selected conditions Rating System level: 5.42 Practice level: 5.42 Numerator Total number of patients/clients who see their primary care provider within 7 days after discharge from hospital for selected conditions Measure source/ data source / data elements/ Timing and frequency of data release System level denominator: Total number of patients discharged from hospital after an admission for one of the following conditions (based on case mix group [CMG]): stroke, COPD, pneumonia, congestive heart failure, diabetes, cardiac conditions and gastrointestinal disorders. Practice level denominator: For Patient Enrolment Models, the denominator Includes patients rostered at the time of discharge with a primary care physician. Follow-up is restricted to professional services provided by a GP/FP, geriatrician or pediatrician in the practice group to which the physician belongs. For CHCs, AHACs and NPLCs, the denominator includes patients who have received care from a provider within the group within the last two years Measure source: Primary Care Quality Improvement Plans System level data source: CIHI/DAD and OHIP Practice level data source: Ministry of Health and Long-Term Care(MOHLTC) portal and CHC report Annual reporting The methodologies used to calculate the measure differ for patient enrollment models and for CHCs/AHACs/NPLCs. This results in slight differences in the definition of the population included in the denominator. 113

116 Measurement priority Measure name Follow-up with regular primary care provider post hospital discharge Follow-up arrangements after hospital discharge Level of reporting System level Availability Measure description Practice level System level: Measure currently reported in recommended form (Province/Other provinces/canada/international) Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients who report that the hospital made arrangements for their follow-up care with a physician or other health care professional Rating System level: 5.00 Practice level: 4.50 Numerator Number of respondents who reported that the hospital made arrangements for their follow-up care with a doctor or other health care professional Measure source/ data source / data elements/ Respondents who were hospitalized overnight in the past 2 years Base (respondents who answered yes): Have you been admitted to the hospital overnight in the past 2 years? Excludes: Not applicable did not need follow up care Not sure Decline to answer Measure source: Commonwealth Fund International Health Policy Survey 2013 System level data source: Commonwealth Fund International Health Policy Survey 2013 Practice level potential data source: Practice level patient experience survey 114

117 Survey question: When you left the hospital, did the hospital make arrangements or make sure you had follow-up care with a doctor or other health care professional? Yes No Not applicable did not need follow up care Not sure Decline to answer Timing and frequency of data release Every three years latest release date

118 Measurement priority Measure name Waiting time for community services Wait time for an appointment for community based health or social services Level of reporting System level Availability Measure description Practice level System level: Measure not currently available; new required for data collection, analysis and reporting (Province/Other provinces/canada/international) Practice level: Measure not currently available; new required for data collection, analysis and reporting Self-reported wait time for patients who were referred to community-based health or social services Rating System level: 4.67 Practice level: 4.25 Numerator Wait time for an appointment to get community based health or social services: Measure source/ data source / data elements/ Days Weeks Months Years This measure will be reported as some measure of the distribution of the wait time (e.g., mean, median, percentile) Respondents who were referred to a community based health or social service in the last 12 months Measure source: New measure, adapted from Commonwealth Fund International Health Policy Survey, 2013 System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey Proposed survey question: In the last 12 months, after you were referred to a community based health or social service how many days, weeks or months did you have to wait for an appointment? 116

119 Timing and frequency of data release Days: Weeks Months Years have not been referred to a community based health or social service in last 12 months don't know refused 117

120 Appendix 9: Effectiveness Domain SMDs Measurement Priority Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. Measure name Level of reporting Availability Measure description Patients with chronic conditions who had a review in the past 12 months System level Practice level System level: Measure not currently available; new required for data collection, analysis and reporting Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients with chronic conditions (asthma, chronic obstructive pulmonary disease [COPD], coronary artery disease, congestive heart failure, hypertension, diabetes) who had a review in the last 12 months Rating Asthma: system level 3.44 practice level 4.33 COPD: system level 4.22 practice level 4.67 CAD: system level 3.67 practice level 4.11 CHF: system level 4.33 practice level 4.78 CVD: system level 3.88 practice level 4.38 Hypertension: system level 4.75 practice level 5.25 Diabetes: system level 4.43 practice level 5.0 Numerator Proportion of patients with a record of an associated assessment within the past 12 months for the following conditions (6 months for diabetes): Asthma Chronic Obstructive Pulmonary Disease (COPD) Coronary Artery Disease (CAD) Congestive Heart Failure (CHF) Cerebrovascular Disorder (CVD) hypertension Diabetes Each reported separately Number of patients who were diagnosed with the following conditions for more than a year (6 months for diabetes): Asthma Chronic Obstructive Pulmonary Disease (COPD) Coronary Artery Disease (CAD) Congestive Heart Failure (CHF) Cerebrovascular Disorder (CVD) Hypertension Diabetes 118 Excludes:

121 Patients newly diagnosed with the conditions of interest in the past 12 months (patients diagnosed within less than 12 months (6 months for diabetes) do not have the required time for a review) Measure source/ data source / data elements/ Measure source: New measure - adapted from Dorval model (for COPD, CHF, CVD and Diabetes) and from literature* for Asthma and hypertension Practice and system level potential data source: EMR/EHR data extraction Original measures (from the Dorval model): Chronic Obstructive Pulmonary Disease (COPD) - Proportion of patients/ clients with COPD who had a clinically relevant review in the past year Coronary Artery Disease (CAD) Proportion of patients/ clients with CAD who had a clinically relevant review in the past year Congestive Heart Failure (CHF) - Proportion of patients/ clients with CHF who had a clinically relevant review in the past year Timing and frequency of data release Cerebrovascular Disorder (CVD) - Proportion of patients/ clients with CVD patients who had a clinically relevant review in the past year Diabetes - Proportion of patients with Diabetes who had a clinically relevant review in the past 6 months This cannot be measured with administrative data as it is not able to distinguish between a regular visit and a review. It is difficult to operationalize as the question would be what constitutes a review. Chronic conditions that are EMR based can help identify patients with chronic conditions. It is suggested that a provincial move in EMR structure to capture review for asthma & CHF is required. It is also suggested that denominator should come from validated registry to identify individuals with these conditions. Two outcomes needs an accepted definition and EMRs capable of accommodating this measure. * S. M. Campbell et al. Quality indicators for General Practice 1998; 20(4):

122 Measurement Priority 120 Measure name Level of reporting Availability Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. Patients with chronic diseases whose last blood pressure reading was below the recommended level System level Practice level System level: Measure not currently available; new required for data collection, analysis and reporting Practice level: Measure not currently available; new required for data collection, analysis and reporting Measure description Percentage of patients with the following conditions whose blood-pressure reading in the last 12 months was below the recommended level for the following conditions Coronary Artery Disease Hypertension Transient ischemic attack (TIA)/Stroke Chronic renal failure Diabetes Rating CAD: system level 4.67 practice level 4.67 Hypertension: system level 4.5 practice level 4.75 TIA/Stroke: system level 5.13 practice level 5.5 Chronic renal failure: system level 4.43 practice level 4.3 Diabetes: system level 4.14 practice level 4.43 Numerator Number of patients who had their blood pressure under the recommended limits for the following conditions: Coronary Artery Disease 140/80 within last 12 months Hypertension 140/80 within last 12 months TIA/Stroke 140/80 within past 15 months Chronic renal failure 130/80 within past 12 months Diabetes 130/80 within past 12 months Number of patients with the following conditions: Coronary Artery Disease Hypertension Transient ischemic attack (TIA)/Stroke Chronic renal failure Measure source/ data source / data elements/ Diabetes Measure source: New measure adopted from the following sources: CAD: Quality and Outcome Framework: United Kingdom National Health Service (NHS) Hypertension: Veteran s Health Administration TIA/stroke: Quality and Outcome Framework: United Kingdom National Health Service (NHS) Chronic renal failure: Dorval model (reworded) Diabetes: CIHI: Voluntary Reporting System System and practice level potential data source: EMR/EHR data extraction.

123 Timing and frequency of data release Evidence and guidelines change over time. As such, indicators will need regular review and update. Note: *Recommended BP levels and mentioned timeframes are subject to change based on changes in the clinical guidelines. 121

124 Measurement Priority Measure name Level of reporting Availability Measure description Rating Numerator Measure source/ data source / data elements/ Timing and frequency of Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. Acceptable cholesterol level in patients with coronary artery disease or a history of TIA/stroke System level Practice level System level: Measure not currently available; new required for data collection, analysis and reporting Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients for the following conditions whose last measured LDL cholesterol in the previous 15 months was 2mmol/l or less: Coronary artery disease History of transient ischemic attack (TIA)/ stroke System level: Stroke: 4.25 CAD: 3.89 Practice level: Stroke: 4.25 CAD:3.78 Number of patients whose last measured LDL control, in the last 15 months, was 2 mmol/l or less, for the following conditions: Coronary artery disease History of TIA/stroke Number of patients with the following conditions: Coronary artery disease History of TIA/stroke Measure source: New measure - modified from Quality and Outcome Framework: United Kingdom National Health Service (NHS) 2013/14 Original measure: The percentage of patients with coronary heart disease whose last measured total cholesterol (measured in the preceding 15 months) is 5mmol/l or less The percentage of patients with stroke or TIA who have a record of total cholesterol in the preceding 15 months System and practice level potential data source: EMR/EHR data extraction and Ontario Laboratories Information System (OLIS). 122

125 data release Evidence and guidelines change over time. As such, indicators will need regular review and update. 123

126 Measurement Priority Measure name Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. Asthma diagnosis confirmed by appropriate testing DEFINTION & SOURCE INFORMATION Level of reporting Availability Measure description System level Practice level System level: Measure not currently available; new required for data collection, analysis and reporting Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients aged 6 years and over whose diagnosis of asthma was confirmed by spirometry or methacholine challenge test Rating System level: 3.67 Practice level: 4.11 Numerator Number of patients aged 6 years and over whose diagnosis* of asthma was confirmed by spirometry, or methacholine challenge test *refers to new diagnosis of asthma (diagnosed in the last 1-2 years) Number of patients with asthma aged 6 years and over Measure Measure source: Literature - Teresa To et al. Evidence based source/ data performance indicators of PC for asthma. International Journal for source / data Quality in Health Care 2010; 22(6): elements/ System level potential data source: Administrative data base and EMR/EHR data extraction Timing and frequency of data release Practice level potential data source: EMR/EHR data extraction From Technical working group: We can potentially use administrative data for this but not for CHCs. There are technical and professional fee codes available for spirometry. It might be limited to only new diagnosis. Operationalizing would include in the last 1 or 2 years. Outcome Administrative data as a potential data source only for new patients. 124

127 Measurement Priority DEFINTION & SOURCE INFORMATION Measure name Level of reporting Availability Measure description Management of chronic conditions including people with mental health and addictions and multiple chronic conditions Appropriate prescribing for patients with asthma System level Practice level System level: Measure not currently available; new required for data collection, analysis and reporting Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients, ages 6 to 55 years, with asthma, who were dispensed high amounts (greater than 4 canisters) of short acting beta2 agonist (SABA) within the past 12 months AND who received a prescription for preventer/controller medication (e.g. inhaled corticosteroid). Rating System level: 3.78 Practice level: 4.67 Numerator Measure source/ data source / data elements/ Timing and frequency of data release Number of patients with asthma, who were dispensed high amounts (greater than 4 canisters) of short-acting beta2-agonist (SABA) within the past 12 months AND who received a prescription for preventer/controller medication (e.g. inhaled corticosteroid) Number of patients, ages 6 to 55 years, with asthma Measure source: Pan-Canadian Primary Health Care Indicator report (2006) : CIHI System and practice level potential data source: EMR/EHR data extraction Comment from technical working group: Potential data source would have to be EMR, no other sources available. 125

128 Measurement Priority Measure name Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. Asthma symptom-free days Level of reporting Availability System level Practice level System level: Measure not currently available; new required for data collection, analysis and reporting Practice level: Measure not currently available; new required for data collection, analysis and reporting Measure description Rating System level: 3.44 Practice level: 3.67 Percentage of patients/people with asthma whose asthma symptoms have been under control during the past four weeks. Numerator Number of patients who reported that they had well or completely controlled asthma over the past 4 weeks: Measure source/ data source / data elements/ Timing and frequency of data release Base (respondents answering yes): Have you ever been told by a doctor or other health provider that you have asthma? Total number of patient who reported having asthma Measure source: Literature - Teresa To et al. Evidence based performance indicators of PC for asthma. International Journal for Quality in Health Care 2010; 22(6): System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey Survey question: How would you rate your asthma control during the past 4 weeks? Not controlled at all Poorly controlled Somewhat controlled Well controlled Completely controlled 126

129 Measurement Priority Measure name Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. COPD diagnosis confirmed by pulmonary function testing Level of reporting Availability System level Practice level System level: Measure not currently available but could be reported using existing (province/lhin) Practice level: Measure not currently available but could be reported using existing Measure Percentage of patients with chronic obstructive pulmonary disease description (COPD) who have had their diagnosis confirmed with pulmonary function testing Rating System level: 4.11 Practice level: 4.89 Numerator Individuals with COPD who had any pulmonary function testing any time from 1 year before the COPD diagnosis date to 1 year following the diagnosis date based on the following OHIP fee codes J301 (simple spirometry) J324 / J327 (spirometry after bronchodilator) J304 (flow volume loop) J307 (body plesthysmography) J310 (carbon monoxide diffusing capacity) J333 (Non-specific bronchial provocative test (histamine, methacholine, thermal, challenge) Measure source/ data source / data elements/ Excludes: Negated OHIP claims, duplicate claims and lab claims Individuals who had an incident diagnosis of COPD between fiscal year 2002/03 and 2011/12 based on more sensitive definition used for ICES derived cohort* Includes: Patients with 1 outpatient claim or 1 hospitalization for COPD Excludes: Individuals who were ineligible for OHIP for at least 2 consecutive quarters during the observation period, using OHIP yearly contact files. Individuals who died within 1 year of their incident diagnosis date Individuals who had Lung Volume reduction surgery or lung transplant prior to diagnosis date Individuals > 99 years of age at time of COPD diagnosis Measure source: from literature* System level potential data source: OHIP database provided by ICES 127

130 Timing and frequency of data release Practice level potential data source: Administrative data (Potentials for primary care practice profile reports) System level data: annually Practice level: NA * Gershon AS, Wang C, Guan J, Vasilevska-Ristovska J, Cicutto L, et al. (2009) Identifying individuals with physician diagnosed COPD in health administrative databases. COPD 6:

131 Measurement Priority 129 Measure Name Level of reporting Availability Measure description Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. Patients with Coronary Artery Disease (CAD) who received the recommended testing to monitor their condition System level Practice level System level: Measure not currently available; new required for data collection, analysis and reporting Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients with Coronary Artery Disease who received the following tests within the last 12 months: Glycated hemoglobin (HbA1c) or fasting blood sugar Lipid profile Blood pressure measurement Obesity screening All of the above Rating System level: 4.22 Practice level: 4.67 Numerator Number of patients with coronary artery disease who received following tests within the last 12 months: HbA1c or fasting blood sugar Lipid profile Blood pressure measurement Obesity screening All of the above Measure source/ data source / data elements/ Timing and frequency of data release : Each reported separately Number of patients with coronary artery disease diagnosis Measure source: From literature* - Practice level potential data source: EMR/EHR data extraction System level potential data source: Ontario Laboratories Information System (OLIS); Administrative data (DAD, RPDB, OHIP) for HbA1c & lipid profiles; EMR/EHR data extraction for blood pressure and obesity screening Technical working group suggested that A1c is not the standard practice. Fasting blood sugar test should be considered as an alternative. Evidence and guidelines change over time. As such, indicators will need regular review and update

132 * Michael E Green et al. Assessing methods for measurement of clinical outcomes and quality of care in primary care practices. BMC Health Services Research 2012; 12:214 Measurement Priority 130 Measure name Level of reporting Availability Measure description Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. Elderly patients hospitalized for an acute myocardial infarction (AMI) who received the recommended treatment post hospitalization System level Practice level System level: Measure currently reported in recommended form (Province, LHIN) Practice level: Measure not currently available but could be reported using existing Percentage of patients aged 65+ on the recommended drugs (Beta-blocker, angiotensin converting enzyme inhibitor/angiotensin receptor blocker, statin) after hospitalization for acute myocardial infarction Rating System level: 4.78 Practice level: 4.89 Numerator Number of patients that within 90 days after the discharge for myocardial infarction filled prescription for:: Beta-blocker Angiotensin converting enzyme inhibitor/angiotensin receptor blocker Statin all three Measure source/ data source / data elements/ Each reported separately For fiscal years of interest, all CIHI inpatient discharges with most responsible diagnosis of acute myocardial infarction (ICD-10 codes: I21 and I22, and ICD-9 code: 410) Excludes: Age < 65 at time of discharge (originally the age range is < 20 years but due to the drug data availability we are limited to do the analysis for those aged 65 or above) Not admitted to an acute care hospital Admitted to non-cardiac surgical service Transferred from another acute care facility AMI within past year AMI coded as in-hospital complication Died within 90 days of discharge Measure source: HQO Quality Monitor Report (2010, 2011) System level data source: Administrative data (Registered Persons Database (RPDB), Discharge Abstract Database (DAD), Ontario Drug Benefits Database (ODB)) provided by ICES

133 Timing and frequency of data release Practice level potential data source: Administrative data (Primary care profile reports); EMR/EHR data extraction System level: annually Practice level: NA ODB eligibility begins at 65 Evidence and guidelines change over time. As such, indicators will need regular review and update. 131

134 Measurement Priority Measure name Level of reporting Availability Measure description Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. Patients with a history of acute myocardial infarction (AMI) who are receiving the recommended drugs System level Practice level System level: Measure not currently available; new required for data collection, analysis and reporting Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients with a history of acute myocardial infarction who are being treated with the following drugs: Angiotensin converting enzyme inhibitor or angiotensin receptor blocker Beta-blocker Statin Rating System level: 4.44 Practice level: 4.78 Numerator Number of patients with a history of AMI who are currently treated with the following drugs: Angiotensin converting enzyme inhibitor or angiotensin receptor blocker Beta-blocker Statin Number of patients with a history of AMI. Measure source/ Measure source: Quality & Outcome Framework: United Kingdom data source / NHS 2013/14 data elements/ System and practice level potential data source: EMR/EHR extraction Original Measure: The percentage of patients with a history of myocardial infarction from 1 April 2011 currently treated with an ACE inhibitor (or ARB if ACE intolerant), aspirin or an alternative anti-platelet therapy, betablocker and statin (unless a contraindication or side effects are recorded) Timing and frequency of data release This measure should be revised based on recent guidelines 132

135 Measurement Priority Measure name Level of reporting Availability Measure description Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. Patients with Coronary Artery Disease (CAD) who are on the recommended drugs System level Practice level System level: Measure not currently available; new required for data collection, analysis and reporting Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients with coronary artery disease who are being treated with anti-platelet agents and statins DEFINTION & SOURCE INFORMATION 133 Rating System level: 4.33 Practice level: 4.56 Numerator Number of patients with CAD who are currently treated with antiplatelet agents and statins. Number of patients with CAD Measure source/ Measure source: Modified -Quality and Outcome Framework: data source / United Kingdom National Health Service (NHS) 2012/13 data elements/ System and practice potential data sources: EMR/EHR extraction and administrative data for patients aged 65 and older (DAD, RPDB, ODB); Timing and frequency of data release Measurement Priority MEASURE DESCRIPTION Measure name Level of reporting Availability Measure description Original measure: The percentage of patients with coronary heart disease who are currently treated with a beta-blocker Evidence and guidelines change over time. As such, indicators will need regular review and update. Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. Patients with congestive heart failure (CHF) who receive the recommended diagnostic testing System level Practice level System level: Measure currently reported in recommended form Practice level: Measure not currently available but could be reported using existing Percentage of patients with new congestive heart failure who have a left ventricular function test

136 DEFINTION & SOURCE INFORMATION Rating System level: 4.33 Practice level: 4.56 Numerator Number of patients with new congestive heart failure who received a left ventricular function test within one year of diagnosis. Number of patients with congestive heart failure Measure source/ Measure source: Canadian Cardiovascular Outcomes Research; data source / Program Evaluation Framework: Alberta data elements/ System level data source: Administrative data (OHIP, DAD) provided by ICES Timing and frequency of data release Practice level potential data source: Administrative data (Primary care profile reports) System level: Annually Practice level: Measurement Priority DEFINTION & SOURCE INFORMATION 134 Measure name Level of reporting Availability Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. Elderly patients hospitalized for congestive heart failure (CHF) who received the recommended treatment post hospitalization System level Practice level System level: Measure currently reported in recommended form Practice level: Measure not currently available but could be reported using existing Measure Percentage of patients aged 65+ on the recommended drugs description (Beta-blocker and angiotensin-converting enzyme inhibitor or angiotensin receptor blocker) after hospitalization for congestive heart failure Rating System level: 4.78 Practice level: 4.89 Numerator Number of patients who within 90 days after the discharge for CHF filled prescription for: Beta-blocker Angiotensin converting enzyme inhibitor/angiotensin receptor blocker both Each reported separately Number of patients discharged with most responsible diagnosis of CHF (ICD-10 codes: I50, and ICD-9 code: 428) Excludes: Age < 65 at time of discharge (originally it s age < 20, due to the drug data availability, we are limited to do the analysis for those aged 65 or above)

137 Measure source/ data source / data elements/ Timing and frequency of data release Not admitted to an acute care hospital Admitted to surgical service Transferred from another acute care facility Previous CHF within the past 3 years* CHF coded as in-hospital complication* Died within 90 days of discharge Measure source: Quality Monitor 2010, System level source: Administrative data (Register Persons Database (RPDB), Discharge Abstract Database (DAD), Ontario Drug Benefits Database (ODBD) provided by ICES Practice level potential data source: Administrative data (Primary care profile reports) System level: Annual Practice level: 135

138 Measurement Priority DEFINTION & SOURCE INFORMATION Measure name Level of reporting Availability Measure description Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. Patients with stroke who are on the recommended medications System level Practice level System level: Measure not currently available; new required for data collection, analysis and reporting Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients with a non-haemorrhagic stroke, or a history of transient ischemic attack (TIA), who have are being treated with an anti-platelet agent or an anti-coagulant Rating System level: 4.38 Practice level: 5.13 Numerator Measure source/ data source / data elements/ Timing and frequency of data release Number of patients with a stroke (non-haemorrhagic) or a history of TIA, who have a record that an anti-platelet agent (aspirin, clopidogrel, dipyridamole or a combination), or an anti-coagulant is being taken Number of patients with a stroke shown to be non-haemorrhagic or a history of TIA Measure source: Quality & Outcome Framework: United Kingdom - NHS System and practice level potential data source: EMR/EHR data extraction and administrative database (for patients over the age of 65) Measurement Priority Measure name Management of chronic conditions including people with mental health and addictions and multiple chronic conditions Glycemic control for patients with diabetes MEASURE DESCRIPTION 136 Level of reporting Availability System level Practice level System level: Measure not currently available; new required for data collection, analysis and reporting Practice level: Measure not currently available; new required for data collection, analysis and

139 reporting Measure description Percentage of patients with diabetes whose glycemic control (HbA1c) in the last 12 months was within the following ranges: HbA1c 7% HbA1c between 7.1%-9% HbA1c > 9% Rating System level: 4.43 Practice level: 4.43 Numerator Measure source/ data source / data elements/ Timing and frequency of data release Number of patients with diabetes whose most recent glycemic test (HbA1c) was in the following ranges: HbA1c 7 % HbA1c between 7.1% - 9% HbA1c > 9 % Each reported separately; may also choose to report only one level Number of patients with diabetes Measure source: CIHI: Voluntary Reporting System System and practice levels potential data source: EMR/EHR data extraction. Evidence and guidelines change over time. As such, indicators will need regular review and update. Measurement Priority Measure name Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. Cholesterol control for patients with diabetes Level of reporting Availability Measure description System level Practice level System level: Measure not currently available; new required for data collection, analysis and reporting Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients with diabetes whose most recent low density lipoprotein (LDL) cholesterol test in the last 12 months was in the following ranges: 2.0 mmol/l > 2.0 mmol/l 137

140 Rating System level: 4.14 Practice level: 4.14 Numerator Number of patients with diabetes whose most recent cholesterol test in the last 12 months was in the following ranges: 2.0 mmol/l > 2.0 mmol/l Measure source/ data source / data elements/ Timing and frequency of data release Each reported separately; may also choose to report only one level Number of patients with diabetes Excludes: Patients whose cholesterol was not tested in the last 12 months Measure source: CIHI: Voluntary Reporting System System and practice level potential data source: EMR/EHR data extraction. Evidence and guidelines change over time. As such, indicators will need regular review and update. Measurement Priority Measure name Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. Control of proteinuria for patients with diabetes Level of System level reporting Availability Measure not currently available; new required for data collection, analysis and reporting. Measure Percentage of patients with diabetes whose albumin/creatinine description ratio the last 12 months was within the following limits: Female 2.8, Male 2.0 Female > 2.8, Male > 2.0 Rating 3.86 DEFINTION & SOURCE INFORMATION Numerator Measure source/ data source / data elements/ Number of patients with diabetes who had the following albumin/creatinine ratio control in the last 12 months: Female 2.8, Male 2.0 Female > 2.8, Male > 2.0 Number of patients with diabetes Measure source: CIHI: Voluntary Reporting System Potential data source: EMR/EHR data extraction. 138

141 Timing and frequency of data release It was suggested that this measure might not be meaningful on its own at the practice level, given that people with diabetes are prone to proteinuria and once it is occurring it is beyond the control of the physician. The measure was taken back to the Measure Working Group to be considered as a system level measure. Evidence and guidelines change over time. As such, indicators will need regular review and update. 139

142 Measurement Priority Measure name Level of reporting Availability Measure description Rating 5.00 Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. Diabetes complications System level Measure currently available in recommended form. Percentage of people with diabetes for more than a year who had a serious diabetes complication (death, heart attack, stroke, amputation or kidney failure) in the past 12 months DEFINTION & SOURCE INFORMATION Numerator Measure source/ data source / data elements/ Timing and frequency of data release Number of patients with diabetes for more than a year who had a serious diabetes complication (death, heart attack, stroke, amputation or kidney failure) in the past 12 months Number of patients with diabetes that are prevalent within the fiscal year of interest. Excludes: Incident Diabetes cases (<1 year in ODD database) Measure source: Quality Monitor 2011 Data source: Administrative data: Discharge Abstract Database, Registered Persons Database & Ontario Diabetes Database Annually. 140

143 Measurement Priority Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. Measure name Providers able to co-ordinate care with service organizations in the community in planning and providing care for their most complex patients Level of System level reporting Availability Measure not currently available; new required for data collection, analysis and reporting. Measure Percentage of providers who are able to coordinate care with description service organizations in the community in planning and providing care for their most complex patients. Rating 4.44 Numerator Measure source/ data source / data elements/ Timing and frequency of data release Number of providers in the denominator who reported that for their most complex patients they are able to co-ordinate care with service organizations in the community in planning and providing care for them. Usually able to Always or almost always able to All respondents Measure source: QualicoPC - Family physician survey Potential data source: Organization or provider reported Survey question: For your most complex patients (e.g. patients with multiple chronic conditions or significant social issues impacting their health) To what extent are you able to co-ordinate care with service organizations in the community in planning and providing care? Unable to Occasionally unable to Sometimes able to Usually able to Always or almost always able to 141

144 Measurement Priority Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. Measure name Providers within the practice have the same information available when caring for their most complex patients. Level of System level reporting Availability Measure not currently available; new required for data collection, analysis and reporting. Measure Percentage of primary care practices/organizations reporting that description all providers caring for complex patients have the same information available to them. Rating 4.56 MEASURE DESCRIPTION 142 Numerator Measure source/ data source / data elements/ Number of providers who reported that for their most complex patients all providers within the practice often or almost always have the same information available to them when working with the these patients All respondents Measure source: Modified-QualicoPC - Family physician survey Potential data source: Organization or provider reported Proposed survey question: For your most complex patients (e.g. patients with multiple chronic conditions or significant social issues impacting their health) To what extent do all providers caring for these patients (within your practice) have the same information available to them when working with the patient? Not at all Not really Unsure Somewhat Very much Often Almost always Original survey question: For your most complex patients (e.g. patients with multiple chronic conditions) To what extent do all providers caring for these patients (within and outside of your practice) have the same information available to them when working with the patient? Not at all Not really Unsure Somewhat Very much

145 Timing and frequency of data release This measure is applicable to only team based model and not for solo practices. Measurement Priority Management of chronic conditions including people with mental health and addictions and multiple chronic conditions Measure name Primary care providers who collaborate with other providers in caring for complex patients Level of System level reporting Availability Measure not currently available; new required for data collection, analysis and reporting. Measure Percentage of primary care providers who report collaborating description with other providers within the practice to establish goals for the treatment and management of complex patients. Rating 4.67 MEASURE DESCRIPTION Numerator Measure source/ data source / data elements/ Number of providers who reported that for their most complex patients within their practice they often or almost always collaborate with all providers caring for these patients in establishing goals for treatment or management and plans All respondents Excludes: Not applicable Measure source: Modified-QualicoPC - Family physician survey Potential data source: Organization or provider reported Proposed survey question: For your most complex patients (e.g. patients with multiple chronic conditions) To what extent do you collaborate with all providers caring for these patients within your practice in establishing goals for treatment or management and plans? Never Rarely Sometimes Often Almost always Not Applicable 143 Original survey question: For your most complex patients (e.g. patients with multiple chronic conditions)

146 To what extent do you collaborate with all providers caring for these patients (within and outside of your practice) in establishing goals for treatment or management and plans? Timing and frequency of data release Never Rarely Sometimes Often Almost always This measure is applicable to only team based model and not for solo practices. 144

147 Measurement Priority Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. Measure name Providers involved in disease management programs for patients with chronic conditions. Level of System level reporting Availability Measure not currently available; new required for data collection, analysis and reporting. Measure Percentage of providers who report that in the past 12 months, description they were involved in disease management program(s) for patients with the following chronic conditions: Chronic heart failure Asthma Chronic obstructive pulmonary disease (COPD) Diabetes Rating 4.38 Numerator Measure source/ data source / data elements/ Timing and frequency of data release Number of respondents who reported that they were involved in a disease management program for patients with the following chronic conditions: Chronic heart failure Asthma COPD Diabetes Each reported separately All respondents Measure source: QualicoPC - Family physician survey Potential data source: Organization or provider reported Survey question: In the past 12 months, have you been involved* in a disease management program for patients with the following chronic conditions? (Such programs are multidisciplinary approaches across practices, often based on protocols. Chronic heart failure Asthma COPD Diabetes Involved in disease management program(s) is hard to interpret 145

148 Measurement Priority MEASURE DESCRIPTION Measure name Level of reporting Availability Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. Providers using a flow sheet or checklist for chronic diseases System level Measure currently available but modified wording recommended (province) Measure description Percentage of primary care physicians who report using a flow sheet or checklist for chronic diseases. Rating 4.44 Numerator Number of providers who reported using a flow sheet or checklist for chronic diseases: Chronic heart failure Asthma Chronic obstructive pulmonary disease (COPD) Diabetes Other (please specify) Measure source/ data source / data elements/ Each reported separately All respondents Measure source: Modified - National Physician Survey 2010 Potential data source: Provider reported Proposed survey question: Do you typically use a flow sheet or checklist for the following chronic diseases? Chronic heart failure Asthma Chronic obstructive pulmonary disease (COPD) Diabetes Other (please specify) Yes No Timing and frequency of data release Original survey question: Do you typically use a flow sheet or checklist for chronic diseases? Yes No Currently the data are not collected and not reported 146

149 147

150 Measurement Priority Measure name Level of reporting Availability Measure description Rating 4.88 Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. Patients with hypertension, heart disease or diabetes who had their blood pressure checked System level (Province/Canada/International) Measure currently reported in recommended form. (Province/Other provinces/canada/international) Percentage of people with hypertension, heart disease, or diabetes who report that they had their blood pressure checked in the past 12 months. Numerator Number of respondents who have hypertension, heart disease, or diabetes who had their blood pressure checked in the past year. Number of respondents who have hypertension, heart disease, or diabetes Measure source/ data source / data elements/ Timing and frequency of data release Base (respondents who answered yes): Do you have Hypertension, sometimes called high blood pressure Heart disease, including angina or heart attack Diabetes Excludes: Not Sure Decline to answer Measure source: Commonwealth Fund International Health Policy Survey 2011 Data source: Commonwealth Fund International Health Policy Survey Survey question: Have you had your blood pressure checked in the past year? Yes No Not Sure Decline to answer Currently the data are collected and reported every three years. 148

151 Measurement Priority Negotiated care plan for patients with chronic conditions. Measure name Level of reporting Availability Measure description Patients with chronic conditions getting help in planning ahead for taking care of their condition System level Practice level System level: Measure not currently available; new required for data collection, analysis and reporting Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients with chronic conditions who report that they received help to plan ahead so they could care for their condition even in hard times. Rating System level: 4.78 Practice level: 4.56 Numerator Measure source/ data source / data elements/ Number of respondents with chronic conditions who reported getting help most of the time or always to plan ahead so they could take care of their condition even in hard times Number of respondents with at least one chronic condition Measure source: Modified The Patient Assessment of Care for Chronic Conditions (PACIC) Survey instrument System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey Proposed survey question: When you received care for your chronic condition, were you helped to plan ahead so you could take care of your condition even in hard times? None of the time A little of time Some of the time Most of the time Always Original survey question: Over the past 6 months, when I received care for my chronic conditions, I was helped to plan ahead so I could take care of my condition even in hard times 149 None of the time A little of time

152 Timing and frequency of data release Some of the time Most of the time Always Note: could be reported by chronic condition if this information were available 150

153 Measurement Priority 151 Measure name Level of reporting Availability Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. Patients with chronic conditions getting treatment choices to think about System level Practice level System level: Measure not currently available; new required for data collection, analysis and reporting Practice level: Measure not currently available; new required for data collection, analysis and reporting Measure Percentage of patients with chronic conditions who report getting description choices about their treatment Rating System level: 4.56 Practice level: 4.56 Numerator Number of respondents with chronic conditions who reported most of the time or always getting choices about their treatment from their doctor/nurse practitioner Measure source/ data source / data elements/ Timing and Number of respondents with at least one chronic condition. Measure source: Modified The Patient Assessment of Care for Chronic Conditions (PACIC) Survey instrument System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey Proposed system and practice level survey question: When you received care for your chronic conditions, were you given choices about treatment to think about? None of the time A little of time Some of the time Most of the time Always Original survey question: Over the past 6 months, when I received care for my chronic conditions, I was given choices about treatment to think about. None of the time A little of time Some of the time Most of the time Always

154 frequency of data release 152

155 Measurement Priority Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. Measure name Patients with hypertension receiving the annual testing Level of reporting Practice level Availability Measure not currently available; new required for data collection, analysis and reporting. Measure Percentage of patients, 18 years and over, with hypertension who description received testing, within the past 12 months, for all of the following: Fasting blood sugar or (HbA1c) Full fasting lipid profile screening; Test to detect renal dysfunction (e.g. serum creatinine); Blood pressure measurement; and Obesity/overweight screening. Rating 4.88 Numerator Number of patients with hypertension who received annual testing for all of the following: Fasting blood sugar or HAb1c Full fasting lipid profile screening Test to detect renal dysfunction (e.g. serum creatinine) Blood pressure measurement Obesity/overweight screening Reporting is for patients who receive all five tests but could be reported separately Number of primary care clients/patients with hypertension, 18 years and over, within the past 12 months Measure source/ data source / data elements/ Timing and frequency of data release Measure source: Pan-Canadian Primary Health care Indicator Project: CIHI Potential data source: EMR/EHR data extraction 153

156 Measurement Priority Management of chronic conditions including people with mental health and addictions and multiple chronic conditions Measure name Patients with hypertension with blood pressure recorded in the previous 9 months Level of reporting Practice level Availability Measure not currently available; new required for data collection, analysis and reporting Measure Percentage of patients with hypertension with blood pressure description recorded in the previous nine months Rating 5.38 MEASURE DESCRIPTION Numerator Measure source/ data source / data elements/ Timing and frequency of data release Number of patients with hypertension in whom there is a record of the blood pressure in the previous 9 months Number of patients with hypertension Measure source: Quality & Outcome Framework: United Kingdom 2012/13 Potential data source: EMR/EHR data extraction. This measure is taken from Quality and Outcome frame work 2012/13. In the most recent 2013/14 this indicator is not included. The two related indicators in the latest QOF are: The percentage of patients under 80 years old with hypertension in whom the last recorded blood pressure (measured in the preceding 9 months) is 140/90 or less The percentage of patients aged 80 years and over with hypertension in whom the last recorded blood pressure (measured in the preceding 9 months) is 150/90 or less 154

157 Measurement Priority Measure name Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. Elderly patients with hypertension prescribed a diuretic Level of reporting System level Practice level Availability System level: Measure currently reported in recommended form Practice level: Measure not currently available but could be reported using existing Measure Percentage of patients aged 65+ newly diagnosed with description hypertension prescribed a thiazide as an anti-hypertensive Rating System level: 4.38 Practice level: 4.63 Numerator The number of patients (66 and older) with newly diagnosed with uncomplicated hypertension whose first prescription was a thiazide or thiazide in combination with other drugs (amiloride, triamterene, or spironolactone, etc) People newly diagnosed with hypertension in the year of interest. Excludes: Age < 66 years on index date (diagnosis date) Previous prescription for hypertension in the 1 year prior to the index date. Patients who had another condition for which a specific antihypertensive drug class may be prescribed. Conditions will be identified in the 4 years prior to OHIP and CIHI and in the 1 year prior in ODB for marker medications. Diagnosed with diabetes one year prior to the index date. Anyone who filled a prescription in the one year period prior to or on the index date for one of the drugs associated with having one of the excluded comorbidities Measure source/ Measure source: Quality Monitor Report 2010 data source / data elements/ System and practice level data source: Registered Persons Database, Ontario Diabetes Database, Ontario Drug Benefits Database, Discharge Abstract Database, Ontario Health Insurance Plan Database, Ontario Hypertension Database Timing and frequency of data release System and practice level potential data source for all patients (including non-seniors): EMR/EHR data extraction Annually 155

158 Measurement Priority Management of chronic conditions including people with mental health and addictions and multiple chronic conditions Measure name Patients with diabetes who had an annual diabetes management assessment Level of reporting System level Practice level Availability System level: Measure currently reported in recommended form Practice level: Measure currently reported in recommended form Measure Percentage of patients with diabetes for whom physicians billed description the diabetes management assessment code (K030) at least once during the past 12 months Rating System level: 4.14 Practice level: 4.86 Numerator Number of patients with diabetes for whom physicians billed the diabetes management assessment code K030 at least once during the past 12 months Measure source/ data source / data elements/ Timing and frequency of data release Number of patients with diabetes Measure source: Primary Care Practice Report System and practice level data source: Ontario Diabetes Database (ODD), OHIP (extracted by ICES) Bi-annually FHTs receives practice report. Equivalent measures are available for CHCs, NPLC and AHAC, extracted from EMR and submitted to ICES 156

159 Measurement Priority Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. Measure name Patients with diabetes who had a body mass index (BMI) recorded in the past 15 months Level of reporting Practice level Availability Measure description Rating 4.43 Measure not currently available; new required for data collection, analysis and reporting Percentage of patients with diabetes with a body mass index (BMI) recorded in the previous 15 months Numerator Measure source/ data source / data elements/ Timing and frequency of data release Number of patients with diabetes with a Body Mass Index recorded in the previous 15 months Number of patients with diabetes Measure source: Quality & Outcome Framework: United Kingdom 2012/13 Potential data source: EMR/EHR data extraction 157

160 Measurement Priority Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. MEASURE DESCRIPTION Measure name Patients with diabetes who had a LDL cholesterol test in the past 12 months Level of reporting Practice level Availability Measure currently reported in recommended form Measure Percentage of patients with diabetes with at least one low-density description lipoprotein (LDL) cholesterol test within the past 12 months Rating 4.57 DEFINTION & SOURCE INFORMATION Numerator Measure source/ data source / data elements/ Timing and frequency of data release Number of patients with diabetes with at least one low-density lipoprotein cholesterol test within the past 12 months Number of patients with diabetes Measure source: Primary Care Physician Practice Report Data source: Ontario Diabetes Database, OHIP defined by the following feecodes- L243, L055, L117 Bi-annually CHC receives practice report. Equivalent measures are available for CHCs, NPLC and AHAC, extracted from EMR and submitted to ICES 158

161 Measurement Priority Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. MEASURE DESCRIPTION Measure name Level of reporting Availability Patients with diabetes receiving glycated hemoglobin testing in the past 12 months Practice level Measure currently reported in recommended form Measure Percentage of patients with diabetes with two or more glycated description hemoglobin (HbA1C) tests within the past 12 months Rating 4.29 DEFINTION & SOURCE INFORMATION Numerator Measure source/ data source / data elements/ Timing and frequency of data release Number of patients with diabetes with two or more glycated hemoglobin tests (HbA1c) within the past 12 months Number of patients with diabetes Measure source: Primary Care Physician Practice Report Data source: Ontario Diabetes Database, OHIP defined by the following OHIP feecode- L093 Bi-annually CHC receives practice report. Equivalent measures are available for CHCs, NPLC and AHAC, extracted from EMR and submitted to ICES 159

162 Measurement Priority Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. MEASURE DESCRIPTION Measure name Level of reporting Patients with diabetes receiving a retinal examination in the past 24 months Practice level Availability Measure currently reported in recommended form Measure description Percentage of patients with diabetes with at least one retinal examination within the past 24 months Rating 4.57 Numerator Measure source/ data source / data elements/ Timing and frequency of data release Number of patients with diabetes with at least one retinal examination within the past two years Number of patients with diabetes Measure source: Primary Care Physician Practice Report Data source: Ontario Diabetes Database, OHIP Defined as visit with one of the following codes A111, A112 - as long as the treating physician specialty is family medicine or general medicine or ophthalmology A233, A234, A235, A236, A238, A239, A240 - as long as the specialist is an ophthalmologist; C233, C234, C235, C236, C238, C239 - as long as the specialist is an ophthalmologist; V401, V405, V406, as long as the specialist is an optometrist; V402, V407 as long as the specialist is an optometrist and diagnosis code (ICD-9) 250 or 362; or A114 as long as diagnosis code 250 or 362 the treating physician specialty is family medicine or general medicine or ophthalmology Bi-annually CHC receives practice report. Equivalent measures are available for CHCs, NPLC and AHAC, extracted from EMR and submitted to ICES 160

163 Measurement Priority Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. MEASURE DESCRIPTION Measure name Patients with diabetes who had a foot exam in the past 12 months Level of reporting Practice level Availability Measure not currently available; new required for data collection, analysis and reporting. Measure Percentage of patients with diabetes who had a foot examination description in the past 12 months. Rating 4.29 Numerator Number of patients with diabetes who had feet examined by a health professional for sores or irritations in the last 12 months Measure source/ data source / data elements/ Timing and frequency of data release Number of respondents who have diabetes Base (Respondents who answer yes): Do you have diabetes? Excludes: Not Sure Decline to answer Measure source: Commonwealth Fund International Health Policy Survey 2011: Canadian Community Health Survey (CCHS) Potential data source: EMR/EHR extraction or practice level patient experience survey Survey question: Have you had your feet examined by a health professional for sores or irritations in the past year? Yes No Not Sure Decline to answer This is currently available as an EMR based measures for CHCs 161

164 Measurement Priority Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. MEASURE DESCRIPTION Measure name Level of reporting Practice level Patients with diabetes who have had a recent microalbuminuria test in the past 15 months Availability Measure not currently available; new required for data collection, analysis and reporting. Measure Percentage of patients with diabetes who have a record of microalbuminuria testing in the previous 15 months description Rating 4.57 Numerator Measure source/ data source / data elements/ Timing and frequency of data release Number of patients with diabetes who have a record of microalbuminuria testing in the previous 15 months Number of patients with diabetes Excludes: Patients who already had proteinuria Measure source: Quality & Outcome Framework: United Kingdom 2012/13 Potential data source: EMR/EHR data extraction 162

165 Measurement Priority Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. Measure name Patients with diabetes who have had a recent estimated glomerular filtration rate or serum creatinine test in the past 15 months Level of reporting Practice level Availability Measure not currently available; new required Measure description Rating 4.43 for data collection, analysis and reporting. Percentage of patients with diabetes who have a record of estimated glomerular filtration rate or serum creatinine testing in the previous 15 months DEFINTION & SOURCE INFORMATION Numerator Measure source/ data source / data elements/ Timing and frequency of data release Number of patients with diabetes who have a record of estimated glomerular filtration rate or serum creatinine testing in the previous 15 months Number of patients with diabetes Measure source: Quality & Outcome Framework: United Kingdom 2012/13 Potential data source: EMR/EHR data extraction 163

166 Measurement Priority Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. MEASURE DESCRIPTION Measure name Elderly patients with diabetes prescribed statins Level of Practice level reporting Availability Measure currently reported in recommended form. Measure description Percentage of patients aged 65+ with diabetes who were prescribed a statin within the past 12 months Rating 4.43 DEFINTION & SOURCE INFORMATION Numerator Measure source/ data source / data elements/ Timing and frequency of data release Number of patients with diabetes aged 66 and older prescribed a statin within the past 12 months Number of patients with diabetes aged 66 and older Measure source: Primary Care Physician Practice Report Data source: ODD, OHIP, ODB Bi-annually Potentially it can be extracted for non-seniors from admin/emr data. 164

167 Measurement Priority Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. MEASURE DESCRIPTION DEFINTION & SOURCE INFORMATION Measure name Elderly patients with diabetes prescribed angiotensin converting enzymes or angiotensin II receptor blockers Level of Practice level reporting Availability Measure currently reported in recommended form Measure Percentage of patients aged 65+ with diabetes who were description prescribed angiotensin-converting enzyme inhibitor or angiotensin II receptor blockers within the past 12 months Rating 4.43 Numerator Number of patients with diabetes aged 66 and older prescribed angiotensin converting enzyme or angiotensin II receptor blockers within the past 12 months Number of patients with diabetes aged 66 and older in last 12 Measure source/ data source / data elements/ Timing and frequency of data release months Measure source: Primary Care Physician Practice Report Data source: ODD, ODB, OHIP Bi-annually Potentially it can be extracted for non-seniors from admin/emr data 165

168 Measurement Priority Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. Measure name Patients with mental health conditions having a review in the past 12 months Level of reporting System level Practice level Availability System level: Measure not currently available; new required for data collection, analysis and reporting Measure description Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients with the following conditions who had a review in the past 12 months: Bipolar disorder Schizophrenia Depression Dementia Rating Bipolar disorder System: 4; Practice: 4.43 Schizophrenia System: 4.14; Practice: 4.57 Depression System: 3.71; Practice: 4.29 Dementia System: 4.71; Practice: 4.86 Numerator Measure source/ data source / data elements/ Timing and frequency of data release Proportion of patients with a recording of an associated assessment within the past 12 months for the following conditions: Bipolar disorder Schizophrenia Depression Dementia Each reported separately Number of patients with the following conditions: Bipolar disorder Schizophrenia Depression Dementia (denominator applies to appropriate population) Measure source: Dorval model & Quality and Outcome Framework: United Kingdom (dementia) 2012/13 System level potential data source: Administrative data Practice level potential data source: EMR/EHR data extraction Can be reported individually or combined 166

169 Measurement Priority Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. Measure name Antidepressant medication monitoring Level of Practice level reporting Availability Measure not currently available; new required for data collection, analysis and reporting. Measure Percentage of patients with depression, newly prescribed an description antidepressant drug by a primary care provider, who have followup contact with a provider in the same practice for review within two weeks Rating 4.14 MEASURE DESCRIPTION Numerator Number of patients, 18 years and over, with depression prescribed an antidepressant drug by a primary care provider, who had follow-up contact with a provider within the same practice for review within two weeks. Measure source/ data source / data elements/ Timing and frequency of data release Includes: PHC client/patient Age of individual is at least 18 years Individual has a diagnosis of depression Individual has a prescription of anti-depressant medication from his or her PHC provider within the past 12 months Number of primary care patients, 18 years and over, with depression who were prescribed antidepressant drug treatment within the past 12 months under the supervision of a primary care doctor. Excludes: Individual had a prescription of anti-depressant medication from his or her PHC provider more than 12 months ago Measure source: Modified - Pan - Canadian Primary Health Care Indicators Project: CIHI Potential data source: EMR/EHR data extraction 167

170 Measurement Priority Measure name Level of reporting Availability Measure description Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. Getting help when dealing with sadness or anxiety System level Practice level System level: Measure currently reported in recommended form (Province/Other provinces/canada/international) Practice level: Measure not currently available; new required for data collection, analysis and reporting Rating System level: 3.86 Practice level: 4.00 Numerator Percentage of people/patients who were able to get help from a professional when dealing with emotional distress such as anxiety or depression in the past two years Number of individuals who were experiencing emotional distress who were able to get help from a professional Number of respondents who have experienced emotional distress such as anxiety or great sadness in the past two years. Measure source/ data source / data elements/ Base (Respondents who answer yes): In the past two years, have you experienced emotional distress such as anxiety or great sadness which you found difficult to cope with by yourself? Excludes: No, did not want to see a professional Not sure Decline to answer Measure source: Commonwealth Fund International Health Policy Survey 2013 System level data source: Commonwealth Fund International Health Policy Survey 2013 Practice level potential data source: Practice level patient experience survey Survey question: When you felt this way, were you able to get help from a professional? Yes No, did not want to see a professional No, could not get help Not sure Decline to answer 168

171 Timing and frequency of data release System level: Every three years Practice level: 169

172 Measurement Priority Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. MEASURE DESCRIPTION Measure name Patients with depression who were asked about suicide Level of reporting Practice level Availability Measure not currently available; new required for data collection, analysis and reporting. Measure Percentage of patients with depression who report being asked by description a provider if they had thoughts about committing suicide or taking their own life. Rating 4.43 Numerator Number of patients with depression who were asked by a provider if they had thoughts about committing suicide or taking their own life. Number of patients with depression Measure source/ data source / data elements/ Timing and frequency of data release Base (Respondents who answer yes): Do you have a mood disorder such as depression, bipolar disorder, mania or dysthymia? Excludes: Don t know Refused to answer Measure source: Program Evaluation Framework: Alberta Potential data source: Practice level patient experience survey Proposed survey question: Has your health care provider ever asked you if you had thoughts about committing suicide or taking your own life? Yes No 170

173 Measurement Priority Management of chronic conditions including people with mental health and addictions and multiple chronic conditions. Measure name Mental health follow-up post hospital discharge Level of reporting System level Practice level Availability System level: Measure currently available in recommended form (Provincially/LHIN) Practice level: Measure not currently available but could be reported using existing Measure Percentage of patients who had a mental health follow-up visit to a description physician (primary care provider or psychiatrist), within seven and 30 days of discharge following hospitalization for a psychiatric condition. Rating System: 5.00 Practice: 4.57 Numerator Patients who had at least one psychiatrist or primary care physician mental health visit of discharge following index hospitalization within: 7 days 30-days 171 Includes: At least one psychiatrist or primary care physician mental health visit taking place in office, home, or long-term care For psychiatrist visits take all OHIP visits with IPDB mainspecialty = psychiatry For identifying primary care physician (mainspecialty = GP/FP or F.P./Emergency medicine ) with mental health visits take any OHIP visit with mental health service codes with a mental health diagnostic code Each reported separately Acute care discharges from episode of care in which a Mental Health and Addiction condition is diagnosed and is coded as most responsible diagnosis in the first hospitalization of the episode within each fiscal year (minus last 7 or 31 days for follow up) from years of interest. Substance-related disorders ICD-10-CA: F55, F10 to F19; DSM-IV: 291.x (0, 1, 2, 3, 5, 81, 89, 9), 292.0, , , , , , , , 292.9, 303.xx (00, 90), 304.xx (00, 10, 20, 30, 40, 50, 60, 80, 90), 305.xx (00, 10 to 90 excluding 80); or Schizophrenia, delusional and non-organic psychotic disorders ICD-10-CA: F20 (excluding F20.4), F22, F23, F24, F25, F28, F29, F53.1; DSM-IV: 295.xx (10, 20, 30, 40, 60, 70, 90), 297.1, 297.3, 298.8, 298.9; or Mood/affective disorders ICD-10-CA: F30, F31, F32, F33, F34, F38, F39, F53.0; DSM-IV: 296.0x, 296.2x, 296.3x, 296.4x, 296.5x, 296.6x, 296.7, , , , 300.4, ; or

174 Anxiety disorders ICD-10-CA: F40, F41, F42, F43, F48.8, F48.9, F93.8; DSM-IV: 300.xx (00, 01, 02, 21, 22, 23, 29), 300.3, 308.3, 309.x (0, 3, 4, 9), , , ; or Selected disorders of adult personality and behaviour ICD- 10-CA: F60, F61, F62, F68, F69, F21; DSM-IV: 301.0, , , , , 301.4, , 301.6, 301.7, , , , Age range to include: years Excludes: Patients without a valid health insurance number Patients without an Ontario residence Gender not recorded as male or female Invalid date of birth, admission date/time, discharge date/time Discharge where the patient signed him/herself out or the patient died Hospitalizations with a subsequent readmission to an acute care hospital within 7 days of discharge following index hospitalization discharge for a most responsible diagnoses of a Mental Health and Addictions condition (see above). Note: if OMHRS records occurs within 24 hours of discharge/admission from institution then this should be considered as part of the same episode of care. Measure source/ data source / data elements/ Timing and frequency of data release Measure source: HQO Yearly Report System level data source: Discharge Abstract Database (DAD), Ontario Mental Health Reporting System (OMHRS), Ontario Health Insurance Plan (OHIP). Practice level potential data source: Administrative data (Physician practice profile reports) Annually Change the wording psychiatric discharges. They are 2 different measures (7 and 30 days of discharge), so it should have 2 numerators. 172

175 Measurement Priority Measure name Advanced disease/palliative Care. Practices providing 24/7 end of life/palliative care MEASURE DESCRIPTION Level of reporting Availability Measure description System level Measure not currently available; new required for data collection, analysis and reporting. Percentage of practices/organizations that report providing 24/7 end-of-life/palliative care. Rating 4.75 Numerator Measure source/ data source / data elements/ Timing and frequency of data release Number of practices who reported providing 24/7 end of life/ palliative care. All respondents Excludes: Not Sure Decline to answer Measure source: Modified-QualicoPC - Family physician survey Potential data source: Organization or provider reported Proposed survey question: Does your practice provide 24/7 palliative/end-of-life care? Yes Yes, but not 24/7 No Not sure Decline to answer Original survey question: Are you or your practice staff involved in the following activities? Palliative care Response options Involved Not involved 173

176 Measurement Priority Negotiated care plan for patients with chronic conditions. Measure name Level of reporting Availability Measure description Patients with chronic conditions who worked out a care plan with their doctor/health care provider System level Practice level System level: Measure not currently available but could be reported using existing Practice level: Measure not currently available but included in survey tool under development; required for data collection, analysis and reporting Percentage of patients who report working out a care plan together with their family physician/nurse practitioner about how to deal with their chronic condition(s). Rating System level: 4.44 Practice level: 4.33 Numerator Number of patients who have at least one chronic condition who worked out a care plan with their provider to deal with their chronic condition(s). Number of respondents who have at least one chronic condition. Measure source/ data source / data elements/ Base (Respondents who selected at least one chronic condition): Have you ever been told by a doctor or other health provider that you have any of the following long-term conditions? None Yes, heart disease Yes, arthritis Yes, high blood pressure or hypertension Yes, depression or anxiety Yes, diabetes Yes, asthma or chronic lung disease such as chronic bronchitis, emphysema, COPD Yes, cancer Yes, high cholesterol Yes, other (please specify): Measure source: Modified- HQO-Primary Care Patient Experience Survey System level potential data source: Population survey Practice level potential data source: HQO-Primary Care Patient Experience Survey System and Practice level survey question: Have you and your doctor/healthcare provider (family doctor, nurse practitioner) worked out a care plan together about how to deal with the chronic illness(es) you have? 174 Yes

177 No Original survey question: Have you and your doctor/healthcare provider(s) worked out a treatment plan together about how to deal with the chronic illness(es) you have? Timing and frequency of data release Yes No 175

178 Measurement Priority Negotiated care plan for patients with chronic conditions. Measure name Level of reporting Availability Patients with chronic conditions asked for ideas when creating their care plan System level Practice level System level: Measure not currently available but could be reported using existing Practice level: Measure not currently available; new required for data collection, analysis and reporting Measure Percentage of patients with chronic conditions who report that they description were asked for their ideas when making a care plan Rating System level: 4.78 Practice level: 4.78 Numerator Number of respondents with chronic conditions who reported their doctor/nurse practitioner most of the time or always asked for ideas when they made a care plan Number of respondents (Note this is a survey of people with Measure source/ data source / data elements/ chronic conditions) Measure source: Modified The Patient Assessment of Care for Chronic Conditions (PACIC) Survey instrument System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey Proposed system and practice level survey question: When you received care for your chronic condition(s), were you asked for your ideas when you and your doctor made a care plan? None of the time A little of time Some of the time Most of the time Always Original survey question: Over the past 6 months, when I received care for my chronic conditions(s), I was asked for my ideas when we made a treatment plan. None of the time A little of time Some of the time Most of the time Always 176

179 Timing and frequency of data release Note: Could also be analyzed by specific condition or number of chronic conditions ; Aligned with Health Links measure 177

180 Measurement Priority Negotiated care plan for patients with chronic conditions. Measure name Level of reporting Availability Measure description Patients with chronic conditions asked about their needs when making the care plan System level Practice level System level: Measure not currently available; new required for data collection, analysis and reporting Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients with chronic conditions who report that they were asked about their needs when making a care plan. Rating* Numerator System level: Practice level: Number of respondents who reported that their doctor/nurse practitioner asked about their needs most of the time or always when they made a care plan Number of respondents who reported having a regular health care provider and receiving a care plan. Measure source/ data source / data elements/ Base (Respondents who selected at least one chronic condition): (Note this is a survey of people with chronic conditions) Measure source: New measure developed based on measures working group recommendation System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey Proposed system and practice level survey question: When I received care for my chronic condition, I was asked about my needs when we made the care plan. None of the time A little of time Some of the time Most of the time Always Timing and frequency of data release 178

181 Note: Could also be analyzed by specific condition or number of chronic conditions Need to develop a standardized care plan for chronic conditions. *This specific measure was not rated as it was proposed by the measures working and as such was not part of the original rating process. 179

182 Measurement Priority Negotiated care plan for patients with chronic conditions. Measure name Level of reporting Availability Patients with chronic conditions receiving a copy of their care plan System level Practice level System level: Measure not currently available; new required for data collection, analysis and reporting Practice level: Measure not currently available; new required for data collection, analysis and reporting Measure Percentage of patients with chronic conditions who reported description getting a copy of their care plan. Rating System level: 4.44 Practice level: 4.44 Numerator Number of respondents with chronic conditions who reported getting a copy of their care plan most of the time or always Measure source/ data source / data elements/ Number of respondents with at least one chronic condition (Note this is a survey of people with chronic conditions) Measure source: Modified The Patient Assessment of Care for Chronic Conditions (PACIC) Survey instrument System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey Proposed system and practice level survey question: When you received care for your chronic illness, were you given a copy of your care plan? None of the time A little of time Some of the time Most of the time Always Original survey question: Over the past 6 months, when I received care for my chronic condition, I was given a copy of my treatment plan. None of the time A little of time Some of the time Most of the time Always 180

183 Timing and frequency of data release Some practices are collecting crude data for patients who got copies of care plans. Consider adding this question in physician survey Note: Could also be analyzed by specific condition or number of chronic conditions Appendix 10: Focus on Population Health Domain SMDs Measurement priority Measure name Health and socio-demographic information about the population being served (including health status) Demographic information Level of reporting System level Practice level Availability System level: Measure currently reported in recommended form (LHIN/Provincial/National/International) Measure description Rating System level: 5.14 Practice level: 5.14 Practice level: Measure not currently available; new required for data collection, analysis and reporting Patient/population demographic information: Age (in years) Gender Income Education Location of residence Sexual orientation Disability Language Immigration Ethno-cultural identity Aboriginal status Social support Mental health status Employment status 181

184 Numerator Measure source/ data source / data elements/ Respondents information on the following characteristics: Age (in years) Gender Income Education Location of residence Sexual Orientation Disability Language Immigration Ethno-cultural identity Aboriginal status Social support Mental health status Employment status Each reported separately Measure source: System level data source: Population surveys and administrative data Practice level potential data source: EMR/EHR data extraction and practice level patient experience survey Timing and frequency of data release TWG comment: This is not a measure but part of equity analysis 182

185 Measurement priority Measure name Health and socio-demographic information about the population being served (including health status) Smoking prevalence Level of reporting System level Practice level Availability System level: Measure currently reported in recommended form (LHIN/Provincial/National) Practice level: Measure not currently available; new required for data collection, analysis and reporting Measure Percentage of people/patients aged 12 and over who report description smoking daily or occasionally Rating System level: 5.14 Practice level: 5.54 Numerator Number of respondents that reported smoking cigarettes daily or occasionally Measure source/ data source / data elements/ All respondents Measure source: Statistics Canada, HQO Yearly Report, CQCO System level data source: Canadian Community Health Survey (CCHS) Practice level potential data source: Practice level patient experience survey and/or EMR/EHR data extraction Practice level survey question: At the present time, do you smoke cigarettes daily, occasionally or not at all? Daily Occasionally Not at all Don t know Refused Timing and frequency of data release System level: Annual Practice level: At system level the CCHS derived variable SMKDSTY ( Type of smoker that indicates the type of smoker the respondent is, based on his/her smoking habits using 4 different questions) is used to report this measure. 183

186 Measurement priority Measure name Health and socio-demographic information about the population being served (including health status) Prevalence of overweight, underweight and obesity Level of reporting Availability Measure description System level Practice level System level: Measure currently reported in recommended form (LHIN/Provincial/National) Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of people / patients who are obese, overweight, underweight, or normal weight based on self-reported weight and height data: Adults aged 18 and over Children aged (obese, overweight or neither) Rating System level: 5.00 Practice level: 4.93 Numerator 1. Number of adult respondents aged 18 and over who were categorized to one of the following categories, according to their self-reported Body Mass Index (BMI): Measure source/ data source / data elements/ - underweight (BMI <18.5) - normal weight (BMI ) - overweight (BMI ) - obese (BMI 30.0) 2. Number of children aged who were categorized to one of the following categories, according to their self-body Mass Index (BMI): obese overweight neither obese nor overweight Each reported separately Number of respondents: aged 18 and over aged Excludes: female respondents who were pregnant or did not answer the pregnancy question) Measure source: Statistics Canada, HQO Yearly Report, CQCO System level data source: Canadian Community Health Survey (CCHS) 184

187 Practice level potential data source: EMR/EHR data extraction (Note: data from EMR would not have to be self-reported) Timing and frequency of data release System level: Annually Practice level: At system level the CCHS derived variable HWTDISW is used to report this measure - Codes for HWTDISW (BMI class): - 1 = Underweight: BMI < = underweight - 2 = Normal weight: <= BMI < 25 = normal - 3 = Overweight: <= BMI < 30 = overweight - 4 = Obese class 1: 2530 <= BMI < 35 = obese (class I) - 5 = Obese class 2: 35 <= BMI < 40 = obese (class II) - 6 = Obese class 3: 40 <= BMI = obese (class III) - 96 = Not applicable - 99 = Not stated - Obese if: - Yes if HWTDISW = 4, 5, or 6 - No if HWTDISW = 1, 2, or 3 - Missing otherwise For ages 12-17: In the Canadian Community Health Survey (CCHS) definitions for overweight, obese, or neither are based on age and gender specific Cole classification system cut-offs. Limitation: The CCHS BMI measure for children is based on self-reported height and weight, which underestimates BMI; and it is using the IOTF BMI cut-offs as opposed to the WHO BMI-forage cut-offs. 185

188 Measurement priority Health and socio-demographic information about the population being served (including health status) Measure name Prevalence of physical inactivity Level of reporting System level (LHIN/Provincial/National/International) Practice level Availability System level: Measure currently reported in recommended form (LHIN/Provincial/National) Practice level: Measure not currently available; new required for data collection, analysis and reporting Measure Percentage of people/patients aged 12 and over who report being description physically inactive Rating System level: 4.50 Practice level: 4.86 Numerator Number or respondents in the denominator who self-report that they are not at all physically active on a weekly basis Measure source/ data source / data elements/ Timing and frequency of data release All respondents aged 12 and over Measure source: Statistics Canada, HQO Yearly Report, CQCO System level data source: Canadian Community Health Survey (CCHS) Practice level potential data source: Practice level patient experience survey Practice level survey question: Thinking about the level of physical activity you do every week, do you consider yourself to be? Very physically active Moderately physically active A bit physically active Not at all physically active Don t know Refused System level: Annual Practice level: At system level the CCHS derived variable PACDPAI was used for reporting this measure. Inactivity was measured via the PACDPAI variable in the CCHS. The PACADPAI has 4 codes associated with it 1,2,3, and 9. 1 and 2 codes for active and moderately active, 3 codes for inactive, while 9 codes for not stated. If 3 was selected, the individual was included in the numerator as physically inactive. 186

189 Measurement priority Measure name Health and socio-demographic information about the population being served (including health status) Prevalence of chronic conditions Level of reporting System level Practice level Availability System level: Measure currently reported but modified wording recommended (Province/Other provinces/canada/international) Measure description Rating System level: 4.86 Practice level: 4.50 Numerator Measure source/ data source / data elements/ Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients/people who report being told that they have the following conditions: Asthma Chronic lung disease such as chronic bronchitis, emphysema or COPD Cancer Depression, anxiety or other mental health problems Diabetes Heart disease or a heart attack High blood pressure or hypertension High cholesterol Any other long-term disease or health problem (specified) Number of respondents who indicated that they were told by a doctor or other health care professional that they have any of the following long-term conditions: - Asthma - Chronic lung disease such as chronic bronchitis, emphysema or COPD - Cancer - Depression, anxiety or other mental health problems - Diabetes - Heart disease or a heart attack - High blood pressure or hypertension - High cholesterol - Any other long-term disease or health problem, please specify All respondents Excludes: - don't know - refused Measure source: Modified- Health Care Experience Survey- MOHLTC/ Practice Level Primary Care Survey- HQO/ Commonwealth Fund International Health Policy Survey

190 System level data source: Health Care Experience Survey- MOHLTC Practice level potential data source: Practice level patient experience survey Proposed survey question: Have you ever been told by a doctor or other health care professional that you have any of the following long-term conditions: Asthma Chronic lung disease such as chronic bronchitis, emphysema or COPD Cancer Depression, anxiety or other mental health problems Diabetes Heart disease or a heart attack High blood pressure or hypertension High cholesterol Any other long-term disease or health problem, please specify Response options yes no Don t know Refused 188 Timing and frequency of data release Original survey question: Have you ever been told by a doctor or other health care professional that you have any of the following long-term conditions: Asthma or chronic lung disease such as chronic bronchitis, emphysema or COPD? Cancer? Depression, anxiety or other mental health problems? Diabetes? Heart disease or a heart attack? High blood pressure or hypertension? High cholesterol? Any other long-term disease or health problem, please specify? Response options yes no Don t know Refused System level: Annual Practice level

191 Measurement priority Measure name Health and socio-demographic information about the population being served (including health status) Annual rate of new cancer diagnoses Level of reporting System level Availability Measure description Measure currently reported in recommended form (Province/LHIN) Annual rate of new cases (incidence) of the following cancers: Male: Prostate Lung and bronchus Colon and rectum Bladder Non-Hodgkin lymphoma Melanoma Leukemia Kidney Stomach Pancreas All other cancers Female: Breast Lung and bronchus Colon and rectum Thyroid Body of uterus Non-Hodgkin lymphoma Ovary Cervical Melanoma Leukemia Pancreas All other cancers Rating

192 Numerator Annual number of new cases diagnosed in Ontario (within specific target population) for the following cancers: Male: Prostate Lung and bronchus Colon and rectum Bladder Non-Hodgkin lymphoma Melanoma Leukemia Kidney Stomach Pancreas All other cancers Female: Breast Lung and bronchus Colon and rectum Thyroid Body of uterus Non-Hodgkin lymphoma Ovary Cervical Melanoma Leukemia Pancreas All other cancers Measure source/ data source / data elements/ Timing and frequency of data release Total at risk population for each cancer Measure source: Cancer Quality Council of Ontario (CQCO) System level data source: Ontario Cancer Registry, Cancer Care Ontario; Population data (Ontario Ministry of Finance. Ontario Population Projections Summary Update (based on the 2006 Census released by Statistics Canada) Annual TWG suggested it s not an appropriate system level measure as it is not related to primary care performance measurement 190

193 Measurement priority Measure name Health and socio-demographic information about the population being served (including health status) Prevalence of the four most common cancers in Ontario MEASURE DESCRIPTION Level of reporting Availability Measure description Rating 4.86 System level Measure currently reported in recommended form (Province/LHIN) Prevalence rate for the four most common cancers: prostate, female breast, colon and rectum, lung Numerator Measure source/ data source / data elements/ Timing and frequency of data release Number of Ontarians diagnosed with the following cancers during the preceding 10 years and were still alive on January 1 st in the year of interest: Prostate Female breast Colon and rectum Lung Each reported separately Total at risk population for each cancer Measure source: Cancer Quality Council of Ontario System level data source: Ontario Cancer Registry, Cancer Care Ontario Annual 191

194 Measurement priority Health and socio-demographic information about the population being served (including health status) Measure name Primary care providers who maintain or have access to a registry of patients with chronic conditions Level of reporting System level Availability Measure currently reported but modified wording recommended (Provincial/National) Measure description Percentage of primary care physicians who report that they maintain or have access to a registry of patients with the following chronic conditions: Asthma Chronic obstructive pulmonary disease (COPD) Coronary artery disease Congestive heart failure Stroke Hypertension Diabetes Chronic kidney disease Mental health conditions Multiple chronic conditions Rating 4.62 Numerator Measure source/ data source / data elements/ Number of respondents who reported that they maintain or have access to a registry of patients with the following chronic conditions: Asthma Chronic obstructive pulmonary disease (COPD) Coronary artery disease Congestive heart failure Stroke Hypertension Diabetes Chronic kidney disease Mental health conditions Multiple chronic conditions Each reported separately All respondents Measure source: Modified -National Physician Survey 2010 System level potential data source: Population survey Proposed survey question: Do you maintain and have access to a registry of patients with the following chronic conditions? 192

195 Asthma COPD Coronary Artery Disease Congestive Heart Failure Stroke Hypertension Diabetes Chronic Kidney Disease Mental Health Conditions Multiple chronic conditions Original survey question: Do you have summary information on your patient population with chronic diseases (e.g., percent of diabetes patients due for an eye exam)? Timing and frequency of data release Yes No o Yearly If no, would you find these useful? TWG suggested that it may be possible to extract this from clinical data; EMR data could be used to identify patients with these chronic conditions. Methodology would need to be tested and validated before it s used. 193

196 Measurement priority Measure name Screening and management of risk factors for cardiovascular disease (CVD) and other chronic conditions (e.g., obesity, smoking, physical inactivity, diet, alcohol and substance abuse, socio-demographic characteristics, sexual and other high risk behaviours) Blood pressure measurement Level of reporting System level Practice level Availability System level: Measure currently reported in recommended form (LHIN/Provincial/National) Measure description Rating System level: 4.85 Practice level: 5.00 Numerator Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients who report having their blood pressure measured within the following time frames: less than 6 months ago 6 months to less than 1 year ago 1 year to less than 2 years ago 2 years to less than 5 years ago 5 or more years ago Number of respondents who reported having their last blood pressure measured in the following time: 194 Measure source/ data source / data elements/ less than 6 months ago 6 months to less than 1 year ago 1 year to less than 2 years ago 2 years to less than 5 years ago 5 or more years ago Each would be reported separately; may also choose to report some pre-defined grouping of categories All respondents who reported having their blood pressure taken Base (Respondents who answered yes): Have you ever had your blood pressure taken? Excludes: Don t know Refused Measure source: Canadian Community Health Survey (CCHS) System level data source: Canadian Community Health Survey (CCHS)

197 Practice level potential data source: Practice level patient experience survey; EMR/EHR data extraction Survey question: When was the last time? [you had your blood pressure taken] Timing and frequency of data release less than 6 months ago 6 months to less than 1 year ago 1 year to less than 2 years ago 2 years to less than 5 years ago 5 or more years ago Don t know Refused System level: Yearly Practice level: NA Note: Canadian Task Force for Preventive Health Care recommends:* Blood pressure measurement at all appropriate primary care visits. For people who are found to have an elevated blood pressure during screening, the (Canadian Hypertension Education program) CHEP criteria for assessment and diagnosis of hypertension should be applied to determine whether the patient meets diagnostic criteria for hypertension. The frequency and timing of blood pressure screening may vary between patients. The risk of high blood pressure and the risk of stroke or heart disease change over a person s natural lifespan and increases with age, comorbidities, and the presence of other risk factors. * Canadian Task Force for Preventive Health care guidelines. Screening for hypertension

198 Measurement priority Screening and management of risk factors for cardiovascular disease (CVD) and other chronic conditions (e.g., obesity, smoking, physical inactivity, diet, alcohol and substance abuse, socio-demographic characteristics, sexual and other high risk behaviours) Measure name Discussion of health risks Level of reporting System level Practice level Availability System level: Measure currently reported but modified wording recommended (Province/Other provinces/canada/international) Measure description Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of people/patients who report having had a discussion within the past 2 years with their health care provider regarding the following health behaviours/ risk factors: A healthy diet and healthy eating Exercise or physical activity The health risks of smoking and ways to quit Alcohol use Unintentional injuries (home risk factors) Unsafe sexual practices Unmanaged psychosocial stress Rating System level: 4.38 Practice level: 4.85 Numerator Number of respondents who reported that they discussed the following risk factors with their health care provider in the past 2 years: A healthy diet and healthy eating Exercise or physical activity The health risks of smoking and ways to quit Alcohol use Unintentional injuries (home risk factors) Unsafe sexual practices Unmanaged psychosocial stress Each reported separately Respondents having a regular primary care provider Base (respondents who answered that they had a regular doctor or regular place): Regular doctor or place? 196 Excludes:

199 Have not seen a doctor in past 2 years Not sure Decline to answer Measure source/ data source / data elements/ Measure source: Modified-Commonwealth Fund International Health Policy Survey 2013 System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey Proposed survey question: During the past 2 years have you and your doctor or other clinical staff at the place you usually go to for care talked about? A healthy diet and healthy eating Exercise or physical activity The health risks of smoking and ways to quit Alcohol use Unintentional injuries (home risk factors), Unsafe sexual practices, and Unmanaged psychosocial stress. Response options Yes No Have not seen a doctor in past 2 years Not sure Decline to answer Original Survey Question: During the past 2 years have you and your doctor or other clinical staff at the place you usually go to for care talked about? A healthy diet and healthy eating Exercise or physical activity The health risks of smoking and ways to quit Alcohol use Timing and frequency of data release Response options Yes No Have not seen a doctor in past 2 years Not sure Decline to answer System level: Every three year Practice level: 197

200 Measurement priority Measure name Screening and management of risk factors for cardiovascular disease (CVD) and other chronic conditions (e.g., obesity, smoking, physical inactivity, diet, alcohol and substance abuse, socio-demographic characteristics, sexual and other high risk behaviours) Breast cancer screening Level of reporting System level Practice level Availability System level: Measure currently reported in recommended form (Province/LHIN) Practice level: Measure currently reported in recommended form Measure Percentage of women aged 50 to 74 who had a mammogram description within the past two years Rating System level: 5.00 Practice level: 5.00 Numerator Total number of Ontario screen-eligible women, years old, who have completed at least one mammogram in a given two-year period Includes: Ontario women (average risk and high risk) aged at the index date Index date was defined as the first screen date per person by screen date in ICMS (Integrated Client Management System) or by service date in OHIP in a two-year period X178 (screening bilateral mammogram) X185 (diagnostic bilateral mammogram) Each woman was counted once regardless of the number of mammograms performed in a two-year period; if a woman had both a program and non-program mammogram within a two-year period, the program status was selected All mammograms in ICMS were counted, including those with partial views Total number of Ontario screen-eligible women, years old (in a given two-year period) Excludes: Women with a missing or invalid HCN, date of birth or postal code Women with an invasive or in-situ breast cancer before the index date. Women with a mastectomy before Jan 1st of the two-year period. 198

201 Measure source/ data source / data elements/ Timing and frequency of data release Measure source: Cancer Quality Council of Ontario, Primary Care Practice Profile Report, HQO Yearly Report System and practice level data source: OHIP (Ontario Health Insurance Program), ICMS (Integrated Client Management System, OCR (Ontario Cancer Registry), PIMS (Pathology Information Management System), CAPE (Client Agency Program Enrolment database), CPDB (Corporate Providers Database), RPDB (Registered Persons Database) System level: Annual Practice level: Primary care practice profile reports- bi-annually Target populations comply with the existing Cancer screening guidelines in Ontario. 199

202 Measurement priority Screening and management of risk factors for cardiovascular disease (CVD) and other chronic conditions (e.g., obesity, smoking, physical inactivity, diet, alcohol and substance abuse, socio-demographic characteristics, sexual and other high risk behaviours) Measure name Colorectal cancer screening Level of reporting System level Practice level Availability System level: Measure currently reported in recommended form (Province/LHIN) Practice level: Measure currently reported in recommended form Measure Percentage of patients aged 50 to 74 who had a fecal occult blood description test (FOBT) within the past two years, sigmoidoscopy or barium enema within five years or a colonoscopy within the past 10 years Rating System level: 4.77 Practice level: 4.77 Numerator Number of screen eligible individuals who had a FOBT within past two years, other investigations (barium enema, sigmoidoscopy) within five years or a colonoscopy within the past 10 years A fecal occult blood testing ( L181 or G004, L179, Q152, Q043, Q133) in the past 2 years received a colonoscopy in the previous 10 years ( Z555 plus one of E740 or E741 or E747 or E705 on the same day)) A rigid sigmoidoscopy (Z535 or Z536) in the previous 5 years A flexible sigmoidoscopy in the previous 5 years (Z555 (without E740 or E741 or E747 or E705 on the same day) or Z580) A single contrast barium enema in the previous 5 years (X112) A double contract barium enema in the previous 5 years (X113) Number of screen-eligible individuals aged 50 to 74 years Measure source/ data source / data elements/ Timing and frequency of data release Excludes: Patients who have had colon cancer or inflammatory bowel disease in the past 5 year. Measure source: Primary Care Practice Report; CQCO System and practice level data source: CIHI, SDS, OCR, OHIP, RPDB System level: Annual Practice level: Primary care practice profile reports- bi-annually 200

203 Alignment issues- There are conflicting age ranges reported by Cancer Care Ontario and Primary Care Practice Reports for fecal occult blood test (FOBT) Target populations comply with the existing Cancer screening guidelines in Ontario. Measurement priority Screening and management of risk factors for cardiovascular disease (CVD) and other chronic conditions (e.g., obesity, smoking, physical inactivity, diet, alcohol and substance abuse, socio-demographic characteristics, sexual and other high risk behaviours) Measure name Colorectal cancer screening with a fecal occult blood test (FOBT) Level of reporting System level Practice level Availability System level: Measure currently reported in recommended form (Province/LHIN) Practice level: Measure currently reported in recommended form Measure Percentage of patients aged 50 to 74 who completed a fecal occult description blood test (FOBT) in the past two years Rating System level: 4.77 Practice level: 4.77 Numerator Total number of Ontario screen-eligible individuals, aged who returned and completed at least one FOBT kit in a given twoyear period Includes: CCC Program FOBT were identified in LRT Non-program FOBT were identified using fee codes in OHIP(G004; L179 L181) Each individual was counted once regardless of the number of FOBTs performed in a two-year period Total number of Ontario screen-eligible individuals, years old, in a given two-year period Excludes: Individuals with a missing or invalid HCN, date of birth, sex or postal code Individuals with an invasive colorectal cancer before Jan 1st of the two-year period Individuals with a total colectomy before Jan 1st of the twoyear period Individuals who had colonoscopy in the past five years or flexible sigmoidoscopy in the past five years Individuals with the Q142A exclusion code for colorectal cancer in the given two-year period Patients who have had inflammatory bowel disease 201

204 Measure source/ data source / data elements/ Timing and frequency of data release Measure source: Cancer Quality Council of Ontario, Primary Care Practice Profile Report System and practice level potential data source: LRT (Laboratory Reporting Tool), OHIP CHDB (Claims History Database), OCR (Ontario Cancer Registry), PIMS (Pathology Information Management System), RPDB (Registered Persons Database) System level: Annual Practice level: bi annually Target populations comply with the existing Cancer screening guidelines in Ontario. 202

205 Measurement priority 203 Measure name Screening and management of risk factors for cardiovascular disease (CVD) and other chronic conditions (e.g., obesity, smoking, physical inactivity, diet, alcohol and substance abuse, socio-demographic characteristics, sexual and other high risk behaviours) Cervical cancer screening Level of reporting System level Practice level Availability System level: Measure currently reported in recommended form (Province/LHIN) Practice level: Measure currently reported in recommended form Measure Percentage of women aged 21 to 69 who had a Papanicolaou description (Pap) smear within the past three years Rating System level: 5.00 Practice level: 5.08 Numerator Number of screen eligible women aged 21 to 69 years who had a Papanicolaou (Pap) smear within the past three years Includes: Index date was defined as the first screen date per person by date of specimen collection in CytoBase or by service date in OHIP in a three-year period Pap tests in Cytobase note all Pap tests in CytoBase were counted, including those with inadequate specimens Identifying Pap tests using fee codes in OHIP (E 430: G365: G394: L713; L733; L812, Q678A) Total number of Ontario screen-eligible women aged years, in a given three-year period Measure source/ data source / data elements/ Timing and frequency of data release Excludes: Women with a missing or invalid HCN, date of birth, LHIN or postal code Women with an invasive cervical cancer before the index date Women with a hysterectomy before the index date. Measure source: Cancer Quality Council of Ontario, Primary Care Practice Profile Report System and practice level data source: OHIP (Ontario Health Insurance Program), Cytobase, OCR (Ontario Cancer Registry), PIMS (Pathology Information Management System), CAPE (Client Agency Program Enrolment database), CPDB (Corporate Providers Database), RPDB (Registered Persons Database) System level: Annually Practice level: bi-annually Target populations comply with the existing Cancer screening guidelines in Ontario.

206 Measurement priority Measure name Immunization through the life span Influenza immunization Level of reporting System level Practice level Availability System level: Measure currently reported in recommended form (Province/Other provinces/canada/international) Practice level: Measure not currently available; new required for data collection, analysis and reporting Measure Percentage of people/patients who report having a seasonal flu description shot in the past year Rating System level: 4.58 Practice level: 4.48 Numerator Number of respondents who reported receiving a seasonal flu shot in the past year All respondents Measure source/ data source / data elements/ Excludes: - Not sure - Decline to answer Measure source: Canadian Community Health Survey (CCHS) / Commonwealth Fund International Health Policy Survey 2013 Statistics Canada (Health Indicators profile) System level data source: Canadian Community Health Survey (CCHS) / Commonwealth Fund International Health Policy Survey Practice level potential data source: Practice level patient experience survey Survey question (CCHS): Base: Have you ever had a seasonal flu shot? - Yes - No - Don t know - Refused When did you have your last seasonal flu shot? -.Less than 1 year ago - 1 year to less than 2 years ago - 2 years ago or more - Don t know - Refused 204 Survey question (CMWF):

207 In the past year, have you had a seasonal flu shot? - Yes - No - Not sure - Decline to answer Timing and frequency of data release System level: Annually Practice level: The CCHS survey population is 12 and older, it is conducted annually and gives an opportunity of interprovincial comparison CMWF survey in general population is conducted every three year, opportunity of international comparison 205

208 Measurement priority Immunization through the life span Measure name Childhood immunization Level of reporting System level Practice level Availability System level: Measure not currently available; new required for data collection, analysis and reporting 206 Practice level: Measure not currently available but could be reported using existing Measure Percentage of children with the following age-appropriate description vaccinations: Within 2 months: DTaP-IPV-Hib*, Pneumococcal Conjugate 13- valent Vaccine, Rotavirus ORAL Vaccine ; within 4 months: DTaP-IPV-Hib*, Pneumococcal Conjugate 13- valent Vaccine, Rotavirus ORAL Vaccine ; within 6 months: DTaP-IPV-Hib*; within 12 months: Pneumococcal Conjugate 13-valent Vaccine, Meningococcal Conjugate C Vaccine, MMR~; Within 15 months: Varicella Vaccine; 18 months: DTaP-IPV-Hib Within 4-6 years: DTaP-IPV #, MMR~ and Varicella Rating System level: 5.17 Practice level: 5.17 Numerator Number of eligible children who had the following age appropriate immunization:: 2 months: DTaP-IPV-Hib*, Pneumococcal Conjugate 13-valent Vaccine, Rotavirus ORAL Vaccine 4 months: DTaP-IPV-Hib*, Pneumococcal Conjugate 13-valent Vaccine, Rotavirus ORAL Vaccine 6 months: DTaP-IPV-Hib* 12 months: Pneumococcal Conjugate 13-valent Vaccine, Meningococcal Conjugate C Vaccine, MMR~ 15 months: Varicella Vaccine 18 months: DTaP-IPV-Hib 4-6 years: DTaP-IPV, MMR~ and Varicella Number of eligible children Measure source/ data source / data elements/ Timing and frequency of data release Measure source: Canadian Institute for Health Information: Voluntary Reporting System System level potential data source: Administrative data (Panorama, a pan-canadian information system in development) Practice level potential data source: EMR/EHR data extraction TWG comment: EMRs are a potential source of data already doing this at CHCs.

209 As per Publicly funded immunization schedules for Ontario: /schedule.pdf Trade names: * Pediacel, Prevnar-13, Rotarix, Menjugate 207

210 Measurement priority Measure name Immunization through the life span Immunizations coverage at seven years of age Level of reporting System level Practice level Availability System level: Measure currently reported in recommended form (Province/public health unit) Practice level: Measure not currently available but could be reported using existing Measure Percentage of school children aged seven years who are fully description vaccinated against diphtheria, tetanus and polio and measles, mumps and rubella Rating System level: 5.17 Practice level: 5.08 Numerator Number of school children age seven years who are known by the health unit to be complete for age for vaccination against diphtheria, polio, and tetanus, or measles, mumps and rubella in a specified time period Measure source/ data source / data elements/ Timing and frequency of data release Each reported separately Number of school children aged seven in that time period Measure source: Association of Public Health Epidemiologists in Ontario (APHEO) System level data source: Immunization Records Information System (IRIS) System and practice level potential data sources: EMR/EHR data extraction; Pan-Canadian Communicable Disease Surveillance and Management Information Technology application (Panorama) System level: annually Practice level: TWG suggested that it may be possible to extract this from clinical data; EMR data could be used to identify patients with these chronic conditions. Methodology would need to be tested and validated before it s used. Public Health Ontario is currently reporting immunization coverage among 7 year olds in Summary of the Immunization Coverage Report for School Pupils, 2011/12 School Year. Ref: /PHO_Monthly_Infectious_Diseases_Surveillance_Report_- _December_2013.pdf 208

211 Measurement priority Immunization through the life span Measure name Hepatitis B vaccination by the end of grade 7 DEFINTION & SOURCE INFORMATION Level of reporting Availability System level Practice level System level: Measure currently reported in recommended form (Province/public health unit) Practice level: Measure not currently available but could be reported using existing Measure Percentage of grade seven students who have completed description vaccination against hepatitis B by the end of grade seven Rating System level: 4.58 Practice level: 4.42 Numerator Number of grade 7 students who have completed vaccination against hepatitis B by the end of grade 7 in a specified time period Total number of Grade 7 students in reported time period Measure source/ Measure source: Association of Public Health Epidemiologists in data source / Ontario (APHEO) data elements/ System level data source: Immunization Records Information System (IRIS) Timing and frequency of data release System and practice level potential data sources: EMR/EHR data extraction Pan-Canadian Communicable Disease Surveillance and Management Information Technology application (Panorama) System level: Annually Practice level: TWG suggested that it may be possible to extract this from clinical data; EMR data could be used to identify patients with these chronic conditions. Methodology would need to be tested and validated before it s used. Public Health Ontario is currently reporting these in Summary of the Immunization Coverage Report for School Pupils, 2011/12 School Year. Ref: /PHO_Monthly_Infectious_Diseases_Surveillance_Report_- _December_2013.pdf (Since the early 1990s, this data has been captured in the Immunization Records Info will be replaced Panorama, over the course of 2013 and 2014 by all 36 PHUs in Onta The measure on 2 dose measles vaccine in 7 year old is included in Common Quality Agenda- HQO and Yearly report 209

212 Measurement priority Measure name Immunization through the life span Meningococcal vaccination by 13 years of age Level of reporting System level Practice level Availability System level: Measure currently reported in recommended form (Province/PHU) Practice level: Measure not currently available but could be reported using existing Measure Percentage of 13-year-olds who have received one dose of the description quadrivalent meningococcal conjugate vaccine on or before their 13th birthday Rating System level: 4.58 Practice level: 4.42 Numerator The number of Ontario students who have received 1 valid dose of MCV4 on or before the age of 13 Measure source/ data source / data elements/ Timing and frequency of data release The number of 13 year-olds enrolled in a public or private school in the province of Ontario, in the year in which immunization coverage is assessed Measure source: Association of Public Health Epidemiologists in Ontario (APHEO)/CQA System level data source: Immunization Records Information System (IRIS) System and practice level potential data sources: EMR/EHR data extraction Pan-Canadian Communicable Disease Surveillance and Management Information Technology application (Panorama) System level: Annually Practice level: TWG suggested that it may be possible to extract this from clinical data; EMR data could be used to identify patients with these chronic conditions. Methodology would need to be tested and validated before it s used. Public Health Ontario is currently reporting these in Summary of the Immunization Coverage Report for School Pupils, 2011/12 School Year. Ref: /PHO_Monthly_Infectious_Diseases_Surveillance_Report_Decem ber_2013.pdf 210

213 Measurement priority Immunization through the life span Measure name Human papillomavirus (HPV) vaccination among females by the end of grade 8 Level of reporting System level Practice level Availability System level: Measure currently reported in recommended form (Province/PHU) Practice level: Measure not currently available but could be reported using existing Measure Percentage of female grade-eight students who have completed description vaccination against human papillomavirus Rating System level: 4.50 Practice level: 4.25 Numerator Number of grade 8 female students who have completed vaccination against human papillomavirus by the end of grade 8 in the specified time period Total number of grade 8 female students in the specified time period. Measure source/ Measure source: Association of Public Health Epidemiologists in data source / Ontario (APHEO) data elements/ System level data source: Immunization Records Information System (IRIS) Timing and frequency of data release System and practice level potential data sources: EMR/EHR data extraction Pan-Canadian Communicable Disease Surveillance and Management Information Technology application (Panorama) System level: Annually Practice level: TWG suggested that it may be possible to extract this from clinical data; EMR data could be used to identify patients with these chronic conditions. Methodology would need to be tested and validated before it s used. Public Health Ontario is currently reporting these in Summary of the Immunization Coverage Report for School Pupils, 2011/12 School Year. Ref: /PHO_Monthly_Infectious_Diseases_Surveillance_Report_Decem ber_2013.pdf 211

214 Measurement priority Immunization through the life span Measure name Pneumococcal immunization among people 65 years of age and over Level of reporting System level Practice level Availability System level: Measure not currently available; new required for data collection, analysis and reporting Practice level: Measure not currently available; new required for data collection, analysis and reporting Measure Percentage of people/patients aged 65+who received a description pneumococcal vaccine in the past 12 months Rating System level: 4.55 Practice level: 4.55 Numerator Number of people, 65 years and over, who have received a pneumococcal immunization in the past 12 months Measure source/ data source / data elements/ Timing and frequency of data release Number of people 65 years and over Measure source: Pan-Canadian Primary Health care Indicator System level potential data source: Population survey Practice level potential data source: EMR/EHR data extraction Guidelines- One dose of Pneu-P-23 vaccine is recommended for all adults 65 years of age and older. Project: CIHI 2006 Potential data source: Limited data (only participating public health units) are available through the Rapid Risk Factor Surveillance System (RRFSS) 212

215 Measurement priority Preventive care for infant and children (beyond immunization) Measure Name Primary care follow-up of healthy newborns within a week after birth Level of reporting System level Availability Measure description Rating 5.29 Numerator Measure currently available in recommended form (Province/LHIN) Percentage of healthy neonates who have had a follow-up appointment with a primary care provider within one week after birth Number of term newborns who had a follow-up visit to a pediatrician or family physician within 7 days of discharge from hospital after birth. Measure source/ data source / data elements/ Timing and frequency of data release Include office and home visits within 7 days after newborn s discharge date from hospital after birth Number of term healthy newborns born to mothers who had vaginal uncomplicated delivery Includes: CMG=576 (Normal Newborn, Singleton Vaginal Delivery) and variable weight >2500 Term >37 gestational week Excludes: Multiple births Small for gestational age infants Measure source: HQO Quality Monitor Data source: DAD (Discharge Abstract Database), OHIP Annually Limitation; Newborns that received follow-up care from a midwife and/or a nurse will not be captured. 213

216 Measurement priority Measure name Preventive care for infant and children (beyond immunization) Children with an enhanced well-baby visit MEASURE DESCRIPTION Level of reporting System level Availability Measure description Measure not currently available but could be reported using existing (Province/LHIN) Percentage of children aged 17 to 24 months with an enhanced well-baby visit Rating 5.21 Numerator Number of children who had an enhanced well-baby visit. (A002 and A268) Measure source/ data source / data elements/ Number of children aged 17 to 24 months Excludes: Children without a valid HCN Measure source: Preliminary evaluation of the uptake of the new fee code for the 18-month enhanced well baby visit in Ontario (ICES) System level potential data source: Administrative data (RPDB & OHIP) Timing and frequency of data release OHIP billings are only considered complete 6 months after the date of service which means that some of the data may be incomplete. Some children in Ontario are seen by primary care providers who may not bill OHIP (such as those seen in Community Health Centres or nurse practitioner led model There is currently no system in place to evaluate the content of the enhanced visit or assess that appropriate referrals are made and developmental services accessed. 214

217 Measurement priority Measure name Level of reporting System level Availability Measure description Rating 4.21 Preventive care for infant and children (beyond immunization) Initiation of breastfeeding Measure currently available in recommended form (LHIN/Province/Canada) Percentage of recent mothers who report breastfeeding or trying to breastfeed Numerator Number of respondents who reported breastfeeding or trying to breastfeed their last baby, even if only for a short time Number of respondents who reported giving birth in the last 5 years (recent mothers) Measure source/ data source / data elements/ Base (Respondents answering yes): Have you given birth in the past 5 years? (excluding stillbirths) Excludes: Don t know Refused Measure source: Canadian Community Health Survey Data source: Canadian Community Health Survey Survey question: For your last baby, did you breastfeed or try to breastfeed your baby, even if only for a short time? Yes No Don t know Refused Timing and frequency of data release Annually TWG comment: Women who breastfeed via pumps may not be captured in this 215

218 Measurement priority Measure name Level of reporting Availability Measure description Rating Preventive care for infant and children (beyond immunization) Breastfeeding at time of discharge from hospital System level Measure currently reported in recommended form (Province/LHIN) Percentage of women who had live term births ( 37 weeks) who exclusively breastfed at the time of discharge from hospital DEFINTION & SOURCE INFORMATION Numerator Measure source/ data source / data elements/ Timing and frequency of data release Total number of women with term live births breastfeeding at discharge Total number of women with term live births Measure source: HQO Quality Monitor Data source: BORN Ontario BORN Information System (BIS) Annually Breast feeding Committee for Canada recommends calculating exclusive breastfeeding using a denominator of live born infants >=37 weeks of gestation at birth and discharged home. However, due to data limitations with the discharge disposition variable it was not possible to further exclude infants who were transferred to NICU or special care unit. 216

219 Measurement priority Measure name DEFINTION & SOURCE INFORMATION Level of reporting Availability Measure description Preventive care for infant and children (beyond immunization) Parental counselling on home injury prevention among children under two years of age System level Measure not currently available; new required for data collection, analysis and reporting Percentage of parents with children under 2 years of age who report being given information on child-injury prevention in the home Rating 4.07 Numerator Number of parents who were given information on child injury prevention in the home Measure source/ data source / data elements/ Timing and frequency of data release Number of parents with children under 2 years Measure source: Pan - Canadian Primary Health care Indicator Project: CIHI 2006 System level potential data source: Population survey 217

220 Measurement priority Measure name Prenatal care Prenatal care in the first trimester DEFINTION & SOURCE INFORMATION Level of reporting Availability System level Practice level System level: Measure currently available in recommended form (Province/LHIN) Practice level: Measure not currently available; new required for data collection, analysis and reporting Measure Percentage of women who gave birth and had a prenatal care description visit in the first trimester Rating System level: 5.23 Practice level: 5.38 Numerator Total number of women who gave birth and had a prenatal visit in the first trimester Total number of women who gave birth Measure source/ data source / data elements/ Timing and frequency of data release Measure source: HQO Quality Monitor System level data source: BORN Ontario BORN Information System (BIS) Practice level potential data source: EMR/EHR data extraction System level: Quarterly Practice level: 218

221 Measurement priority Measure name 219 Level of reporting Availability Prenatal care Primary care practices/physicians offering prenatal, intrapartum (delivery) and postpartum care System Level Measure currently reported but modified wording recommended Measure description Percentage of primary care physicians who report that they offer the following services in their practice: Prenatal care Intrapartum care Postpartum care Rating 4.42 Numerator Measure source/ data source / data elements/ Timing and frequency of data release Number of respondents in denominator who reported to offer the following services in their practice: Prenatal care Intrapartum care Postpartum care Each reported separately All respondents Measure source: Modified-National Physician survey 2010 System level potential data source: Administrative data (OHIP feecodes P004 P006) Proposed survey question: Please indicate if you OFFER the following to your patients and if this is a SPECIFIC AREA OF FOCUS in your practice: Pre--natal care Intra-partum care Postpartum care Original survey question: Please indicate if you OFFER the following to your patients and if this is a SPECIFIC AREA OF FOCUS in your practice: Prenatal care Intrapartum care Last time this measure was reported NPS 2010 The NPS is a national physician survey that has a limited response rate and so may not be reflective of the entire population of providers; additionally data is only available for family physicians and general practitioners and does not include nurse practitioners. Beginning in 2012, NPS became an annual survey with each survey focusing on key topics that will change over time. The Administrative data base for suggested as a potential data

222 source and need further review. 220

223 Appendix 11: Efficiency Domain SMDs Measurement priority Measure Name Per capita health care cost (primary care, specialist care, hospital care, diagnostics, pharmaceuticals, long-term care, community care) Health care expenditures by sector Level of reporting Availability System level Measure not currently available but could be reported using existing (province/ LHIN) Measure description Expenditures for the following sectors, expressed per capita and as a percentage of total provincial health care expenditures: Physicians and practitioners (i.e., payments under OHIP) Operations of hospitals Prescription drugs Long-Term care homes Community care All others Rating 4.58 Numerator Measure source/ data source / data elements/ Timing and frequency of data release Total expenditure for each sector: Doctors and Practitioners (i.e., payments under OHIP) Operations of Hospitals Prescription Drugs Long-Term Care Homes Community Care All others Reported separately as two sets of measures; by per capita expenditure and percentage of total provincial health care expenditure Per capita: Total mid-year population in one fiscal year Percentage of total provincial health care expenditure: Total provincial government health expenditure Measure source: Ministry of Health and Long-term Care, Ministry of Health Promotion and Sport System level potential data source: Ministry of Health and Longterm Care, Ministry of Health Promotion and Sport 221

224 This indicator was reported cross-sectionally. Data from 2010/11 available from: ml 222

225 Measurement priority Measure Name Per capita health care cost (primary care, specialist care, hospital care, diagnostics, pharmaceuticals, long-term care, community care) Per capita health care expenditures by category Level of reporting Availability System level Practice level System level: Measure currently reported in recommended form (province/lhin) Measure description Practice level: Measure currently reported in recommended form Per-capita health care expenditures by category: Inpatient hospitalization Same-day surgery ED visits Visits to dialysis clinics Visits to cancer clinics Ontario Drug Benefit (ODB) Rehabilitation Complex & continuing care Home care services OHIP physician billings, including most of the shadow-billings OHIP lab claims OHIP non-physician billings FHO/FHN capitation Long-term care Admissions to designated mental health beds Assisted Device Program (ADP) DEFINTION & SOURCE INFORMATION 223 Rating* Numerator System level: Practice level: Total health care expenditure by category: - Inpatient hospitalization - Same Day Surgery - ED visits - Visits to dialysis clinics - Visits to cancer clinics - Ontario Drug Benefit - Rehabilitation - Complex & Continuing Care - Home Care services - OHIP Physician billings, including most of the shadow-billings - OHIP Lab claims - OHIP non-physician billings - FHO/FHN capitation - Long-Term Care - Admissions to designated mental health beds

226 - Assisted Device Program Measure source/ data source / data elements/ Timing and frequency of data release Total mid-year population for the fiscal year of interest Measure source: Institute for Clinical and Evaluative Sciences (ICES) System level data source: Institute for Clinical and Evaluative Sciences (ICES) Practice level data source: Institute for Clinical and Evaluative Sciences (ICES) *This measure was not rated as it was added after the rating phase. 224

227 Measurement priority Measure Name Level of reporting Availability Measure description Per capita health care cost (primary care, specialist care, hospital care, diagnostics, pharmaceuticals, long-term care, community care) (cross-referenced with Appropriate Resources domain) Operational expenses in primary care System Level Measure not currently available; new required for data collection, analysis and reporting (province/lhin) Average annual per capita primary care operational expenditures for: Health human resources o General practitioners/family physicians; o Nurse practitioners; o Other primary care providers; Supplies Equipment Administration/overhead Other Rating 4.23 Numerator Measure source/ data source / data elements/ Timing and frequency of data release Total annual funding for the following operational expenditures: Health human resources o General Practitioners/Family Physicians; o Nurse Practitioners; o Other PHC providers; Supplies Equipment Administration/overhead Other Total mid-year population for fiscal year of interest Measure source: Pan-Canadian Primary Health Care Indicators (2006) Potential data source: Ministry of Health and Long Term care administrative data 225

228 Measurement priority Measure Name Unnecessary duplication of diagnostic tests/imaging (crossreferenced with Integration domain) Unnecessary testing in primary care Level of reporting Availability Measure description System level Practice level System level: Measure currently reported but modified wording recommended (Province/Other provinces/canada/international) Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients who report there was a time in the past two years when physicians ordered a medical test that they felt was unnecessary because the test had already been done Rating System level: 4.58 Practice level: 4.64 Numerator Number of respondents who reported there was a time when doctors ordered a medical test that they felt was unnecessary because the test had already been done All respondents Measure source/ data source / data elements/ Excludes: Not applicable Not sure Decline to answer Measure source: Modified- Commonwealth Fund International Health Policy Survey (CMWF) 2013 System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey Proposed survey question: Now thinking about the past 2 years, when getting care for a medical problem, was there ever a time when a health care provider ordered a medical test that you felt was unnecessary because the test had already been done Yes No Not applicable Not sure Decline to answer 226

229 Original survey question: Now thinking about the past 2 years, when getting care for a medical problem, was there ever a time when doctors ordered a medical test that you felt was unnecessary because the test had already been done Yes No Not applicable Not sure Decline to answer Timing and frequency of data release 227

230 Measurement priority Unnecessary duplication of diagnostic tests/imaging Measure Name Problems in care coordination and information exchange within the practice Level of reporting Availability System level Measure currently not available; new required for data collection, analysis and reporting (province/lhin) Measure Percentage of primary care providers who report that the following description occurred with their patients during the past month: Medical records or other relevant clinical information were not available at the time of a patient s scheduled visit Tests or procedures had to be repeated because findings were unavailable A patient experienced problems because care was not well coordinated across multiple sites or providers Rating 4.42 Numerator Number of respondents who reported that the following occur with their patients: Medical records or other relevant clinical information was not available at the time of a patients scheduled visit Tests or procedures had to be repeated because findings were unavailable A patient experienced problems because care was not well coordinated across multiple sites or providers Measure source/ data source / data elements/ Reported separately All respondents Measure source: CIHI: Provider Survey Potential data source: Provider or Organization survey Survey question: During the past month, did the following occur with any of your patients? Medical record(s) or other relevant clinical information was not available at the time of a patients scheduled visit Tests or procedures had to be repeated because findings were unavailable A patient experienced problems because care was not well coordinated across multiple sites or providers yes no Timing and frequency of data 228

231 release Measurement priority Measure Name Implementation and meaningful use of electronic medical records/ electronic Health Records Use of electronic clinical records Level of reporting Availability Measure description Rating 4.67 System level Measure currently reported in recommended form (province/lhin) Percentage of primary care physicians who report using electronic records instead of paper charts to enter and retrieve patient clinical notes Numerator Number of respondents who reported that they use electronic records instead of paper charts to enter/retrieve patient clinical notes All respondents Measure source/ data source / data elements/ Timing and frequency of data release Excludes: Not applicable I do not provide patient care Measure source: National Physician Survey 2010 Potential data source: Provider or organization reported Survey question: Thinking about your main patient care setting, which of these describes your record keeping system? I use paper charts only I use a combination of paper and electronic charts to enter and retrieve patient clinical notes I use electronic record instead of paper charts to enter/relieve patient clinical notes Not applicable I do not provide patient care 229

232 Measurement priority Measure Name Implementation and meaningful use of electronic medical records/ electronic Health Records Use of electronic technology Level of reporting Availability Measure description System level Measure currently reported in recommended form (Province/Other provinces/canada/international) Percentage of primary care physicians who report using the following technologies in their practice: Electronic ordering of laboratory tests Electronic alerts or prompts about a potential problem with drug dose or drug interaction Electronic referring to specialists Electronic prescribing of medication Rating 4.67 Numerator Number of respondents who reported occasionally or routinely using the following technologies in their practice: Measure source/ data source / data elements/ Electronic ordering of laboratory tests Electronic alerts or prompts about a potential problem with drug dose or drug interaction Electronic referring to specialists Electronic prescribing of medication Reported separately Total number of respondents Excludes: Don t know Decline to answer Measure source: Commonwealth Fund International Health Policy Survey Provider Survey Data source: Commonwealth Fund International Health Policy Survey Provider Survey Survey question: Do you use any of the following technologies in your practice? Would you say routinely, occasionally or no? 230 Electronic ordering of laboratory tests

233 Electronic alerts or prompts about a potential problem with drug dose or drug interaction Electronic referring to specialists Electronic prescribing of medication Yes, routinely Yes, occasionally No Don t know Decline to answer Timing and frequency of data release Every three years 231

234 Measurement priority Measure Name Implementation and meaningful use of electronic medical records/ electronic Health Records Electronic exchange of information with other doctors Level of reporting Availability Measure description Rating 4.67 Numerator System level Measure currently reported in recommended form (Province/Other provinces/canada/international) Percentage of primary care physicians who report being able to electronically exchange the following with other physicians outside their practice: Patient clinical summaries Laboratory and diagnostic tests Number of respondents who reported that they electronically exchange the following with other physicians outside their practice: - Patient clinical summaries - Laboratory and diagnostic tests Total number of provider survey respondents Measure source/ data source / data elements/ Excludes: Don t know Decline to answer Measure source: Commonwealth Fund International Health Policy Survey Provider Survey Data source: Commonwealth Fund International Health Policy Survey Provider Survey Survey question: Can you electronically exchange the following with any doctors outside your practice? A. Patient clinical summaries B. Laboratory and diagnostic tests Yes No Don t know Decline to answer Timing and frequency of data release 232

235 Measurement priority Measure Name Implementation and meaningful use of electronic medical records/ electronic Health Records Electronic medical records system functionality 233 Level of reporting Availability Measure description Rating 5.08 Numerator Measure source/ data source / data elements/ System level Measure currently reported in recommended form (Province/Other provinces/canada/international) Percentage of primary care physicians who report being able to generate the following patient information with their current patient medical records system: List of patients by diagnosis (e.g., diabetes or cancer) List of patients by laboratory result (e.g., HbA1C>9.0) List of patients who are due or overdue for tests or preventive care (e.g., flu vaccine due) List of all medications taken by an individual patient (including those that may be prescribed by other physicians) List of all patients taking a particular medication List of all laboratory results for an individual patient (including those ordered by other physicians) Clinical visit summaries for patients Number of respondents who stated that it was easy to generate the following via a computerized system patient medical records system: List of patients by diagnosis (e.g., diabetes or cancer) List of patients by laboratory result (e.g., HbA1C>9.0) List of patients who are due or overdue for tests or preventive care (e.g., flu vaccine due) List of all medications taken by an individual patient (including those that may be prescribed by other doctors) List of all patients taking a particular medication List of all laboratory results for an individual patient (including those ordered by other doctors) Provides patients with clinical summaries for each visits Reported separately for all response levels for both components of the question (all means and computerized) All respondents Excludes: - Not sure - Decline to answer Measure source: Commonwealth Fund International Health Policy Survey 2012 Provider survey Data source: Commonwealth Fund International Health Policy

236 Survey 2012 Provider survey Survey question: With the patient medical records system you currently have, how easy would it be for you (or staff in your Practice) to generate the following information about your patients? Is this process computerized? List of patients by diagnosis (e.g., diabetes or cancer) List of patients by laboratory result (e.g., HbA1C>9.0) List of patients who are due or overdue for tests or preventive care (e.g., flu vaccine due) List of all medications taken by an individual patient (including those that may be prescribed by other doctors) List of all patients taking a particular medication List of all laboratory results for an individual patient (including those ordered by other doctors) Provides patients with clinical summaries for each visits Easy Somewhat difficult Difficult Cannot generate Not sure Decline to answer Response options for: Is this process for Computerized? Yes No Timing and frequency of data release Every 3 years Measurement priority Self-management support and collaborating with patients and families MEASURE DESCRIPTION Measure Name Level of reporting Availability Provision of written instructions on self-management to patients with chronic conditions System level Measure currently reported in recommended form (Province/Other provinces/canada/international) 234

237 Measure description Rating 4.64 Percentage of primary care physicians who report that they routinely give patients with chronic conditions written instructions on how to manage their own care at home Numerator Measure source/ data source / data elements/ Timing and frequency of data release Number of respondents who report that they routinely give their patients with chronic conditions written instructions about how to manage their own care at home All respondents Measure source: Commonwealth Fund International Health Policy Survey 2012 Provider survey Data source: Commonwealth Fund International Health Policy Survey 2012 Provider survey Survey question: Do you give your patients with chronic conditions written instructions about how to manage their own care at home? Yes, routinely Yes, occasionally No Every 3 years 235

238 Measurement priority Measure Name Self-management support and collaborating with patients and families (Cross-referenced with Effectiveness and Patient-Centeredness domains) Patients receiving relevant and useful information on staying healthy Level of reporting Availability Measure description System level Practice level System level: Measure not currently available; new required for data collection, analysis and reporting (province/lhin) Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients who report that they received relevant and useful advice or information at their primary care visits on staying healthy and avoiding illnesses Rating System level: 4.00 Practice level: 4.36 Numerator Number of respondents who reported that the doctor/healthcare provider(s) they saw at the visit was excellent or very good at providing relevant and useful advice/information about how to stay healthy generally, how to prevent illness, etc Measure source/ data source / data elements/ All respondents Measure source: Practice Level Patient Experience Survey (HQO) System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey Survey question (for in office survey): On a scale of poor to excellent, how would you rate the following.? The doctor/healthcare provider(s) you saw at this visit providing you with relevant and useful advice/information about how to stay healthy generally, how to prevent illness, etc. poor fair good very good excellent 236 Alternative survey question (for population or out-of-office practice-level patient experience survey): On a scale of poor to excellent, how would you rate your family doctor, nurse practitioner or other healthcare providers in their office regarding how they provide you with relevant and useful advice/information about how to stay healthy generally, how to

239 prevent illness, etc. Timing and frequency of data release - poor - fair - good - very good - excellent 237

240 Measurement priority Measure Name Level of reporting Availability Self-management support and collaborating with patients and families Patients receiving emotional support from their primary care provider System level Practice level System level: Measure not currently available but could be reported using existing (province/ LHIN) Measure description Practice level: Measure not currently available; new required for data collection, analysis and reporting Percentage of patients who report that their main primary care provider supported them in the following ways: Helped them feel that their everyday activities, such as diet and lifestyle, make a difference in their health Helped them feel that they could prevent some health problems Gave them a sense of control over their health Helped them feel that sticking with their treatment would make a difference Helped them feel confident about their ability to take care of their health 238 Rating System level: 3.91 Practice level: 4.36 Numerator Measure source/ data source / data elements/ Number of respondents in the denominator who stated (yes definitely) that the person they saw the most at this practice did the following: Help then feel that their everyday activities such as diet and lifestyle make a difference in their health Help them feel that they could prevent some health problems Give them a sense of control over their health Help them feel that sticking with their treatment would make a difference Help them feel confident about their ability to take care of their health Reported separately All respondents Measure source: QualicoPC: Patient experience survey System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey

241 Survey question: Over the past 12 months, did the person you saw most at this practice. Help you feel that your everyday activities such as diet and lifestyle make a difference in your health? Help you feel that you could prevent some health problems? Give you a sense of control over your health? Help you feel that sticking with your treatment would make a difference? Help you feel confident about your ability to take care of your health? Timing and frequency of data release Yes, definitely Yes, to some extent No, not really No, not at all 239

242 Measurement priority Measure Name Self-management support and collaborating with patients and families Information provided to patients with chronic conditions about community programs Level of reporting Availability Measure description System level Practice level System level: Measure not currently available but could be reported using existing (province/ LHIN) Practice level: Measure not currently available; new required for data collection, analysis and reporting Rating System level: 3.92 Practice level: 4.17 Numerator Measure source/ data source / data elements/ Percentage of patients with chronic conditions who report that they were provided with information about whether there were programs in the community that could help them deal with their chronic conditions Number of respondents who reported that they were definitely provided with information about programs in the community that could help them deal with their chronic conditions Number of respondents who are diagnosed or treated for any of the following chronic health conditions: heart disease, arthritis or rheumatoid arthritis, high blood pressure or hypertension, depression or anxiety, diabetes or other chronic health problems Base (respondents who answered yes): Has any health professional ever diagnosed you with or treated you for any of the following chronic health conditions? Heart disease Arthritis or rheumatoid arthritis High blood pressure or hypertension Depression or anxiety Diabetes Other Excludes: I haven t needed the help of community programs in the past 6 months Measure source: Modified- CIHI: Patient Experience Survey System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey 240

243 Proposed survey question: When you received care for your chronic condition(s), were you provided with information about programs in the community that could help you? Yes No Don t know I haven t needed the help of community programs in the past 6 months [excluded] Original survey question: When you received care for your chronic condition(s), were you encouraged to attend programs in the community that could help you? Yes, definitely Yes, probably Maybe, not sure No, not really No, definitely not I haven t needed the help of community programs in the past 6 months Timing and frequency of data release 241

244 Measurement priority Patient wait times in office Measure Name Level of reporting Availability Measure description Rating 4.42 Time from the scheduled appointment time to time the appointment started Practice level Measure not currently available; new required for data collection, analysis and reporting Patient-reported wait times from when their consultation was scheduled to start to when they met with a healthcare provider 242 Numerator Measure source/ data source / data elements/ Timing and Wait time for patient consultation: from its scheduled time to when they actually met with a healthcare provider: immediately less than 5 minutes 5 to 10 minutes 11 to 20 minutes 21 to 30 minutes more than 30 minutes This measure will be reported as some percent of patients receiving care within a pre-determined threshold value All respondents Excludes: there was no set time for my consultation Measure source: Practice Level Patient Experience Survey (HQO) Potential data source: Practice level patient experience survey. Survey question: How long did you wait for your consultation to start from its scheduled time to when you actually met with a healthcare provider? Immediately Less than 5 minutes 5 to 10 minutes 11 to 20 minutes 21 to 30 minutes More than 30 minutes There was no set time for my consultation

245 frequency of data release 243

246 Measurement priority Patient wait times in office Measure Name Patients seeing their provider within 20 minutes of their appointment time Level of reporting Availability Measure description Practice level Measure not currently available; new required for data collection, analysis and reporting Percentage of patients who report that during the last 12 months, they saw their primary care provider within 20 minutes of their appointment time: - Always - Usually 244 Rating 3.75 Numerator Measure source/ data source / data elements/ Number of respondents who stated that during the last 12 months they saw their [family doctor, nurse practitioner's] usually or always within 20 minutes of their appointment time Always Usually All respondents Measure source: Modified- CAHPS- Clinician & Group Survey Potential data source: Practice level patient experience survey Proposed survey question (for in office survey): Wait time includes times spent in the waiting room and examination room. In the last 12 months, how often did you see [family doctor's, nurse practitioner's] practice within 20 minutes of your appointment time? Never Sometimes Usually Always Alternative survey question (for out-of-office survey e.g. by post or by ): When you visited your [family doctor's, nurse practitioner's] practice during the last 12 months, how often did you see the provider within 20 minutes of your appointment time? (Wait time includes times spent in the waiting room and exam room.) Never Sometimes Usually Always

247 Timing and frequency of data release Original survey question: In the last 12 months, how often did you see the provider practice within 15 minutes of your appointment time? (Wait time includes times spent in the waiting room and examination room.) Never Sometimes Usually Always 245

248 Measurement priority Patient wait times in office Measure Name Rating of time spent in the waiting room Level of reporting Availability Measure description Practice level Measure not currently available; new required for data collection, analysis and reporting Percentage of patients who rated the length of time they had to wait for their consultation to start from its scheduled time to when they saw the healthcare provider as: Very good Excellent Rating 4.08 Numerator Number of respondents who rated the length of time they had to wait for their consultation to start from its scheduled time to when they actually saw the healthcare provider (family doctor or nurse practitioner) as very good or excellent All respondents Measure source/ data source / data elements/ Excludes: Not applicable Measure source: Practice Level Patient Experience Survey (HQO) Potential data source: Practice level patient experience survey Survey question (for in office survey): On a scale of poor to excellent, how would you rate the following.? The length of time you had to wait for your consultation to start from its scheduled time to when you actually saw the doctor/healthcare provider Poor Fair Good Very good Excellent Not applicable 246 Alternative survey question (for out-of-office survey e.g. by post or by ): The last time you visited your [family doctor's, nurse practitioner's] practice, how would you rate the length of time you had to wait for your consultation to start from its scheduled time to when you

249 Timing and frequency of data release actually saw the healthcare provider (family doctor or nurse practitioner) Poor Fair Good Very good Excellent Not applicable 247

250 Measurement priority Patient wait times in office Measure Name Wait time in the examination room Level of reporting Availability Measure description Rating 4.00 Practice level Measure not currently available; new required for data collection, analysis and reporting Patient-reported wait times from when they were taken into the examination room to when they saw the healthcare provider Numerator Measure source/ data source / data elements/ Wait time for consultation: from the time the respondent was taken into the examination room to when they saw the healthcare provider: Immediately Less than 5 minutes 5 to 10 minutes 11 to 20 minutes 21 to 30 minutes More than 30 minutes This measure will be reported as the percent of patients receiving care within a pre-determined threshold value All respondents Measure source: Practice Level Patient Experience Survey (HQO) Potential data source: Practice level patient experience survey Survey question (for in office survey): How long did you wait for your consultation to start from the time you were taken into the examination room to when you saw the healthcare provider? [If you saw more than one person, this applies to the first person you saw] Immediately Less than 5 minutes 5 to 10 minutes 11 to 20 minutes 21 to 30 minutes More than 30 minutes 248 Alternative survey question (for out-of-office survey e.g. by

251 Timing and frequency of data release post or by ): The last time you visited your [family doctor's, nurse practitioner's] practice, how long did you wait for your consultation to start from the time you were taken into the examination room to when you saw the healthcare provider? [If you saw more than one person, this applies to the first person you saw] Immediately Less than 5 minutes 5 to 10 minutes 11 to 20 minutes 21 to 30 minutes More than 30 minutes 249

252 Measurement priority Patient wait times in office Measure Name Rating of wait time in the examination room Level of reporting Availability Measure description Practice level Measure not currently available; new required for data collection, analysis and reporting Percentage of patients who rated the length of time they had to wait from when they were taken to the examination room to when the health care provider (family doctor or nurse practitioner) showed up as: Very good Excellent Rating 3.25 Numerator Number of respondents who rated the length of time they had to wait from when they were taken to the examination room and when the health care provider (family doctor or nurse practitioner) showed up as very good or excellent All respondents Measure source/ data source / data elements/ Excludes: Not applicable Measure source: Practice Level Patient Experience Survey (HQO) Potential data source: Practice level patient experience survey Survey question: On a scale of poor to excellent, how would you rate the following..? The length of time you had to wait from when you were taken to the examination room and when the healthcare provider showed up Poor Fair Good Very good Excellent Not applicable 250 Alternative survey question (for out-of-office survey e.g. by post or by ): The last time you visited your [family doctor's, nurse practitioner's] practice, how would you rate the length of time you had to wait from when you were taken to the examination room and when the

253 Timing and frequency of data release healthcare provider (family doctor or nurse practitioner) showed up Poor Fair Good Very good Excellent Not applicable 251

254 Appendix 12: Safety Domain SMDs Measurement Priority Infection prevention and control Measure Name Level of reporting Availability Measure description Rating 4.50 Monitoring of compliance with infection control policies and procedures System level Measure not currently available; new required for data collection, analysis and reporting (province/lhin) Percentage of primary care organizations reporting that they monitor compliance with their infection prevention and control policies and procedures Numerator Measure source/ data source / data elements/ Number of respondents that reported monitoring compliance with organizational infection prevention and control policies and procedures Total number of organizations that have infection prevention policies and procedures Base (respondents who answer yes): Does your organization have infection prevention policies and procedures? Measure source: Accreditation Canada Potential data source: Organization-reported Proposed survey question: Does your organization monitor compliance with its infection prevention and control policies and procedures? Yes No Don t know Timing and frequency of data release 252

255 Measurement Priority Infection prevention and control Measure Name Level of reporting Availability Hand hygiene education and training System level Measure not currently available; new required for data collection, analysis and reporting (province/lhin) Measure description Percentage of primary care organizations reporting that they provide hand hygiene education and training for staff, service providers and volunteers Rating 4.50 Numerator Measure source/ data source / data elements/ Timing and frequency of data release Number of respondents that reported delivering hand hygiene education and training for staff, service provider and volunteers Total number of organizational respondents Measure source: Accreditation Canada Potential data source: Organization-reported Proposed survey question: Does your organization provide hand hygiene education and training for staff, service providers, and volunteers? Yes No Don t know 253

256 Measurement Priority Measure Name Infection prevention and control Monitoring of compliance with hand hygiene practices Level of reporting Availability Measure description Rating 4.67 System level Measure not currently available; new required for data collection, analysis and reporting (province/lhin) Percentage of primary care organizations reporting that they evaluate their compliance with accepted hand hygiene practices Numerator Measure source/ data source / data elements/ Timing and frequency of data release Number of respondents that reported evaluating their compliance with accepted hand-hygiene practices Total number of organizational respondents Excludes: Don t know Measure source: Accreditation Canada Potential data source: Organization-reported Proposed survey question: Does your organization evaluate its compliance with accepted hand-hygiene practices? Yes No Don t know 254

257 Measurement Priority Infection prevention and control Measure Name Level of reporting Availability Measure description Rating 4.58 Provision of infection prevention education to patients and families System level Measure not currently available; new required for data collection, analysis and reporting (province/lhin) Percentage of primary care organizations reporting that they provide patients and families with information and education about preventing infections Numerator Measure source/ data source / data elements/ Timing and frequency of data release Number of respondents reporting that the organization provides patients and families with information and education about preventing infections Total number of organizational respondents Excludes: Don t know Measure source: Accreditation Canada Potential data source: Organization-reported Proposed survey question: Does your organization provide patients and families with information and education about preventing infections? Yes No Don t know 255

258 Measurement Priority 256 Measure Name Level of reporting Availability Medication management, including medication reconciliation Patient knowledge of new prescription medication System level Practice level System level: Measure not currently available but could be reported using existing (Province/Other provinces/canada/international) Practice level: Measure not currently available; new required for data collection, analysis and reporting Measure description Percentage of patients who, in the past two years, were not sure what a new prescription medication was for or when or how to take it Rating System level: 5.00 Practice level: 5.00 Numerator Number of respondents who received a new prescription medication in the past two years and recall a time when they were not sure what it was for or when or how to take it All respondents Measure source/ data source / data elements/ Timing and frequency of data Excludes: I haven t received a new prescription medication in the past 2 years Decline to answer Not sure Measure source: Commonwealth Fund International Health Policy Survey 2010 System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey Survey question: In the past two years, when you received a new prescription medication, was there ever a time when you were not sure what it was for or when or how to take it? Yes, there was a time I was not sure No I haven t received a new prescription medication in the past 2 years Not sure Decline to answer

259 release Measurement Priority Measure Name Medication management, including medication reconciliation Prescription medication review Level of reporting Availability System level Practice level System level: Measure currently reported in recommended form Practice level: Measure currently not available; new required for data collection, analysis and reporting Measure description Percentage of patients who report that, in the past 12 months, they had a review and discussion with their primary care provider of prescription medications they are using Rating System level: 4.45 Practice level: 4.83 Numerator Number of respondents who reported that their primary care provider reviewed and discussed with them the prescription medicines they are using All respondents 257 Measure source/ data source / data elements/ Timing and frequency of data release Excludes: Don t Know Refused Measure source: Health Care Experience Survey (HCES) (Ministry of Health and Long-Term Care) System level data source: Health Care Experience Survey (HCES) Practice level potential data source: Practice level patient experience survey Survey question: In the last 12 months, has your [fill fd_type]* reviewed and discussed with you the prescription medicine you are using? Yes No Don t know Refused Quarterly

260 Reviews with pharmacists would not be captured in the question *fd_type is the variable in the HCES used to denote the type of provider (family doctor/ nurse practitioner) the respondent has seen. Measurement Priority Measure Name Level of reporting Medication management, including medication reconciliation Provision of a list of prescription medications to patients System level Availability Measure currently reported but modified wording recommended (Province/Other provinces/canada/international) Measure description Percentage of patients who are using 2 or more prescription medications who report that, in the past 12 months, a health care provider gave them a written list of all their prescription medications Rating 4.30 Numerator Number of respondents who report their doctor, nurse practitioner or pharmacist gave them a written list of all their prescription medications in the past 12 months Respondents who are taking at least two prescription medications Measure source/ data source / data elements/ Base (respondents who identified two or more as their response or who indicated that they were taking more than one prescription medication): How many different prescription medications are you taking on a regular or ongoing basis? Excludes: Not sure Decline to answer Measure source: Modified - Commonwealth Fund International Health Policy Survey 2013 Potential data source: Population survey Proposed survey question: In the past 12 months, has a doctor, nurse practitioner or pharmacist given you a written list of all your prescribed medications? Yes No 258

261 Not sure Decline to answer Original question In the past 12 months, has a doctor or pharmacist given you a written list of all your prescribed medications? Timing and frequency of data release Yes No Not sure Decline to answer Every three years 259

262 Measurement Priority Measure Name Medication management, including medication reconciliation Discussion of potential side effects Level of reporting Availability System and Practice level System level: Measure currently reported but modified wording recommended (Province/Other provinces/canada/international) Practice level: Measure currently not available; new required for data collection, analysis and reporting Measure description Percentage of patients who report that, in the past 12 months, a health care provider explained the potential side effects of any medication that was prescribed Rating System level: 4.73 Practice level: 4.82 Numerator Number of respondents who report their doctor, nurse practitioner or pharmacist explained the potential side effects of any medication that was prescribed to them Respondents who are taking at least two prescription medications Measure source/ data source / data elements/ Base (respondents who identified two or more as their response or who indicated that they were taking more than one prescription medication): How many different prescription medications are you taking on a regular or ongoing basis? Excludes: Not sure Decline to answer Measure source: Modified - Commonwealth Fund International Health Policy Survey 2013 System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey Proposed survey question: In the past 12 months, has a doctor, nurse practitioner or pharmacist explained the potential side effects of any medication that was prescribed? 260 Yes No Not sure

263 Decline to answer Survey Question: In the past 12 months, has a doctor or pharmacist explained the potential side effects of any medication that was prescribed? Timing and frequency of data release Yes No Not sure Decline to answer Every three years 261

264 Measurement Priority Measure Name Level of reporting Medication management, including medication reconciliation Use of electronic prescribing alerts System level Availability Measure currently not available; new required for data collection, analysis and reporting (province/lhin) Measure description Percentage of primary care providers/organizations that report using the medication alert function in their EMR Rating 5.36 Numerator Measure source/ data source / data elements/ Timing and frequency of data release Number of respondents that currently use client/patient specific medication alerts within their electronic prescribing/drug ordering system All respondents with an electronic prescribing/drug ordering system Base (respondents who answer yes): Do you have an electronic prescribing/drug ordering system? Excludes: Not sure Measure source: Modified - Pan-Canadian Primary Health care Indicator Project: CIHI 2006 Potential data source: Provider or organization-reported Proposed survey question: Do you use the medication alert function in your electronic medical record system? Yes No Not sure 262

265 Measurement Priority Recognition and management of adverse events including medical errors Measure Name Level of reporting Availability Measure description Rating 4.27 Patient-reported negative reactions to medication System level Measure currently available but modified wording recommended (Province/Other provinces/canada/international) Percentage of patients who report having a negative reaction to a medication prescribed by their primary care provider that resulted in a visit to the hospital in the past two years Numerator Number of respondents who reported that in the past 2 years, they had a negative reaction to a medicine prescribed by their primary health care provider which resulted in them going to the hospital Total number of respondents taking prescription medicine that was prescribed by their primary health care provider Measure source/ data source / data elements/ Excludes: - Not sure - I have not been prescribed a medication by my family doctor/nurse practitioner in the past two years - Decline to answer Measure source: Modified- Commonwealth Fund International Health Policy Survey 2011 Potential data source: Population survey Proposed survey question: In the past 2 years, have you had a negative reaction to any medicine prescribed by your family doctor/nurse practitioner that resulted in you going to the hospital? Yes No Not sure I have not been prescribed a medication by my family doctor/nurse practitioner in the past two years Decline to answer Original survey question: In the past 2 years, have you had a negative reaction to any medicine that resulted in you going to the hospital? 263 Yes

266 No Not sure Decline to answer Timing and frequency of data release Every three years 264

267 Measurement Priority Measure Name Level of reporting Availability Measure description Rating 4.20 Recognition and management of adverse events including medical errors Patient-reported medical mistakes System level Measure currently reported in recommended form (Province/Other provinces/canada/international) Percentage of patients who believe a medical mistake was made in their care during the past two years Numerator Number of respondents who reported that they thought a medical mistake was made in their treatment or care in the past 2 years All respondents Measure source/ data source / data elements/ Timing and frequency of data release Excludes: Not sure Decline to answer Measure source: Commonwealth Fund International Health Policy Survey 2013 Data source: Commonwealth fund International Health Policy Survey 2013 Survey question: In the past 2 years, was there a time you thought a medical mistake was made in your treatment or care? Yes No Not sure Decline to answer Every three years 265

268 Measurement Priority Measure Name Level of reporting Availability Measure description Rating 4.20 Numerator Recognition and management of adverse events including medical errors Patient-reported severity of problems resulting from medical mistakes System level Measure not currently available but could be reported using existing (Province/Other provinces/canada/international) Percentage of patients who report having experienced a serious problems as a result of a medical mistake during the past two years Number of respondents who reported that the medical mistake they experienced resulted in a somewhat or very serious problem. Respondents who experienced a medical mistake over the past 2 years Base (respondents who answered yes to any of the following questions): In the past 2 years, have you ever been given the wrong medicine or wrong dose at a pharmacy or while hospitalized? Measure source/ data source / data elements/ In the past 2 years, do you believe a medical mistake was made in your treatment or care? In the past 2 years, have you? - Been given incorrect results for a diagnostic or lab test - Experienced delays in being notified about abnormal test results Excludes: Not sure Decline to answer Measure source: Commonwealth Fund International Health Policy Survey 2011 Potential data source: Population survey Survey question: Did this mistake, medication error, or diagnostic test error cause a? 266 Very serious problem Somewhat serious problem Not serious problem No problem at all Not sure

269 Decline to answer Timing and frequency of data release 267

270 Measurement Priority Measure Name Level of reporting Availability Recognition and management of adverse events including medical errors Opportunity to discuss problems with medications System level Practice level System level: Measure not currently available; new required for data collection, analysis and reporting (province/lhin) Practice level: Measure not currently available; new required for data collection, analysis and reporting Measure description Percentage of patients with chronic conditions who report having been asked in the past six months about medicationrelated problems Rating System level: 4.45 Practice level: 4.82 Numerator Number of respondents who reported being asked most of the time or always about any problems they had with their medications Respondents* Measure source/ data source / data elements/ Timing and frequency of data release Measure source: Modified - Patient Assessment of Chronic Illness Care (PACIC) System level potential data source: Population survey Practice level potential data source: Practice level patient experience survey Proposed survey question: When I received care for my chronic illness at my family doctor s/nurse practitioner s office over the past 6 months, I was asked to talk about any problems with my medicines or their effects Almost never Generally not Sometimes Most of the time Always *Respondents in this case was limited to people with chronic conditions 268

271 Measurement Priority Measure Name Level of reporting Availability Measure description Rating 4.20 Recognition and management of adverse events including medical errors Informing patients about medical errors System level Measure currently reported in recommended form (Province/Other provinces/canada/international) Percentage of patients who report that the health professional involved told them a medical error had been made in their treatment Numerator Total number of respondents in the denominator who reported that the doctor or health professional involved told them that a medical error had been made in their treatment Number of respondents who have been given wrong medication/dose or thought a medical mistake was made in their treatment in the past two years Measure source/ data source / data elements/ Base (respondents who answer yes to any question): In the past 2 years, have you ever been given the wrong medication or wrong dose by a doctor, nurse, hospital or pharmacist? In the past two years, was there a time you thought a medical mistake was made in your treatment or care? Excludes: Not sure Decline to answer Measure source: Commonwealth Fund International Health Policy Survey 2013 Data source: Commonwealth Fund International Health Policy Survey Survey question: Did the doctor or health professional involved tell you that a medical error had been made in your treatment? Timing and frequency of data release Yes No Not sure Decline to answer Every three years 269

272 Measurement Priority Measure Name Level of reporting Availability Measure description Rating 5.00 Recognition and management of adverse events including medical errors Incident reporting system System level Measure currently not available; new required for data collection, analysis and reporting (province/lhin) Percentage of primary care organizations that report having an incident reporting system to identify and address potentially serious adverse events Numerator Measure source/ data source / data elements/ Timing and frequency of data release Number of respondents who report having an incident reporting system to identify and address potentially serious adverse events All respondents Excludes: Don t know Measure source: Quality Book of Tools System level potential data source: Organization-reported Proposed survey question: Do you have an incident reporting system to identify and address potentially serious adverse events? Yes No Don t know 270

273 Measurement Priority Measure Name Level of reporting Availability Measure description Rating 4.67 Numerator Measure source/ data source / data elements/ Timing and frequency of data release Recognition and management of adverse events including medical errors Necessary equipment and drugs to treat anaphylaxis System level Measure currently not available; new required for data collection, analysis and reporting (province/lhin) Percentage of primary care practices/organizations that report having the equipment and in-date emergency drugs to treat anaphylaxis Number of respondents who report having the equipment and in-date emergency drugs to treat anaphylaxis All respondents Excludes: Don t know Measure source: Quality and Outcome Framework Potential data source: Provider or organization-reported Proposed survey question: Does your practice/organization have the equipment and indate emergency drugs to treat anaphylaxis? Yes No Don t know 271

274 Measurement Priority Measure Name Level of reporting Availability Measure description Rating 4.82 Numerator Measure source/ data source / data elements/ Timing and frequency of data release Recognition and management of adverse events including medical errors Monitoring of expiry dates of emergency drugs System level Measure currently not available; new required for data collection, analysis and reporting (province/lhin) Percentage of primary care practices/organizations that report having a system to check the expiry dates of emergency drugs on at least an annual basis Number of respondents who report having a system to check the expiry dates of emergency drugs on at least an annual basis All respondents Base: Don t know I think we have a process but I don t know how it works Measure source: Quality and Outcome Framework Potential data source: Provider/organization-reported Proposed survey question: Does your practice/organization have a system for checking the expiry dates of emergency drugs on at least an annual basis? Yes No Don t know 272

275 Measurement Priority Measure Name Level of reporting Availability Measure description Recognition and management of adverse events including medical errors System for reporting medical errors System level Measure currently not available; new required for data collection, analysis and reporting (province/lhin) Percentage of primary care organizations that report having a process for reporting medical errors that is non-prejudicial and confidential Rating 4.91 Numerator Number of respondents who report having a non-prejudicial, confidential process within the practice for reporting medical errors. All respondents Measure source/ data source / data elements/ Timing and frequency of data release Excludes: Don t know Measure source: Adapted from CIHI Provider Survey Potential data source: Organization-reported Proposed survey question: Do you have a non-prejudicial, confidential process in your organization for reporting medical errors? Yes No Don t know 273

276 Measurement Priority Measure Name Level of reporting Availability Measure description Rating 4.91 Numerator Measure source/ data source / data elements/ Timing and frequency of data release Recognition and management of adverse events including medical errors System for reporting medical errors System level Measure currently not available; new required for data collection, analysis and reporting (province/lhin) Percentage of primary care organizations that report having a process for addressing medical errors that is non-prejudicial and confidential for staff members who may have made a medical error Number of respondents who report having a non-prejudicial, confidential process within the practice for reporting medical errors. All respondents Excludes: Don t know Measure source: Adapted from CIHI Provider Survey Potential data source: Organization-reported Proposed survey question: Do you have a process for addressing medical errors that is non-prejudicial and confidential for staff members who may have made a medical error? Yes No Don t know 274

277 Appendix 13: Appropriate Resources Domain SMDs Measurement Priority Measure Name Level of reporting Availability Measure description Rating 5.22 Funding and Use of Electronic systems to link with other settings Electronic transfer of prescriptions to a pharmacy System level Measure currently reported in recommended form (Province/Other provinces/canada/international) Percentage of primary care physicians who reported being able to electronically transfer prescriptions to a pharmacy Numerator Number of respondents who report being able to electronically transfer prescriptions to a pharmacy Number of respondents who report electronically prescribing medication Measure source/ Data source /data elements/ Timing and frequency of data release Base (respondents who answered yes): Do you use any of the following technologies in your practice? Electronic prescribing of medication Measure source: Commonwealth Fund International Health Policy Survey 2012 System level data source: Commonwealth Fund International Health Policy Survey 2012 Survey question: Are you able to electronically transfer prescriptions to a pharmacy? Yes No Every three years 275

278 Primary Care Provider remuneration by funding model (For System level) Measurement Priority Measure Name Funds received by primary care practice (by category) Funding of primary care organizations operating costs Level of reporting System level Availability Measure not currently available; new required for data collection, analysis and reporting (province/lhin) Measure description Percentage of primary care organizations funding of their operating costs that comes from: Overhead charges to physicians Private enterprises (companies, pharmacies, donations, foundations) Fees charged to patients (e.g. fees to open or manage files) Health system budget (hospital) Infrastructure operating grant or government program Rating 4.22 Numerator Measure source/ Data source /data elements/ Number of respondents who report that the funding of their clinic operating cost comes from the following categories: Overhead charges to physicians Private enterprises (companies, pharmacies, donations, foundation) Fees charged to patients (e.g. fees to open or manage files) Health system budget (hospital) Infrastructure operating grant or government program Each reported separately All respondents Measure source: CIHI Organizational Survey Potential data source: Organization-reported Survey question: Does the funding of your clinic's operating costs come from: Overhead charges to physicians Private enterprises (companies, pharmacies, donations, foundation) Fees charged to patients (e.g. fees to open or manage files)? Health system budget (hospital)? Infrastructure operating grant or government program? 276

279 yes no Timing and frequency of data release 277

280 Measurement Priority Funds received by primary care practice (by category) Measure Name Level of reporting Availability Measure description Rating 4.33 Primary care overhead costs System level Measure currently reported in recommended form (province) Percentage of income that primary care physicians report spending on overhead Numerator Percentage of gross professional income that goes towards running the practice Measure source/ Data source /data elements/ Timing and frequency of data release All respondents Excludes: - Measure source: National Physician Survey 2010 (NPS) System level potential data source: Provider-reported Survey question: What percentage of your gross professional income goes towards running your practice (e.g., part-time or full-time staff, leases/rent/mortgage, equipment leasing/rental, personal benefits, vehicles costs, professional fees, malpractice dues, other overhead expenses)? % Annually. (Latest data available in 2010) The NPS is a national physician survey that has a limited response rate and so may not be reflective of the entire population of providers; additionally data is only available for family physicians and general practitioners and does not include nurse practitioners. Beginning in 2012, NPS became an annual survey with each survey focusing on key topics that will change over time. 278

281 Measurement Priority 279 Measure Name Level of reporting Availability Measure description Rating 4.40 Numerator Measure source/ Data source /data elements/ Healthy work environments and safety Workplace safety of primary care providers System level Measure not currently available; new required for data collection, analysis and reporting (province/lhin) Percentage of primary care providers who report that there are adequate provisions to ensure their safety in their workplace, by type of provider Number of providers who report that there are currently adequate provisions to ensure their safety in their workplace, by type of provider FP/GP Nurse practitioner Registered nurse Audiologist Chiropractor Dietitian Occupational therapist Pharmacist Physiotherapist Psychologist Optometrist Social worker Speech-language pathologist Other Each reported separately All respondents Excludes: Don t know Measure source: Pan-Canadian Primary Health care Indicator Project: CIHI 2006 Potential data source: Provider-reported Proposed survey question: Do you feel there are adequate provisions to ensure your safety within the practice in which you work? Yes No Don t know

282 Timing and frequency of data release Data for nurses are potentially available from the National Survey of the Work and Health of Nurses however, the survey was only completed once in Measurement Priority Healthy work environments and safety Measure Name Level of reporting Availability Measure description Rating 4.60 Work absence due to primary care provider burnout System level Measure not currently available; new required for data collection, analysis and reporting (province/lhin) Percentage of primary care providers who report missing two weeks or more of work due to burnout during the past 12 months, by type of provider Numerator Number of providers who report having missed work due to burnout over the past 12 months, by the following types of providers: FP/GP Nurse practitioner Registered nurse Audiologist Chiropractor Dietitian Occupational therapist Pharmacist Physiotherapist Psychologist Optometrist Social worker Speech-language pathologist Other Each reported separately All respondents Excludes: Decline to answer 280

283 Measure source/ Data source /data elements/ Timing and frequency of data release Measure source: Pan-Canadian Primary Health care Indicator Project: CIHI 2006 Potential data source: Provider-reported Proposed survey question: Have you missed work for 2 weeks or more over the past 12 months due to burnout? Yes No Decline to answer Measurement Priority Healthy work environments and safety Measure Name Level of reporting Availability Measure description Rating 4.90 Workplace injury System level Measure not currently available; new required for data collection, analysis and reporting (province/lhin) Percentage of primary care providers who report having a workplace-related injury during the past 12 months, by type of provider DEFINTION & SOURCE INFORMATION Numerator Number of providers who had a workplace related injury over the past 12months, by type of provider FP/GP Nurse practitioner Registered nurse Audiologist Chiropractor Dietitian Occupational therapist Pharmacist Physiotherapist Psychologist Optometrist Social worker Speech-language pathologist 281

284 Other Measure source/ Data source /data elements/ Timing and frequency of data release Each reported separately All respondents Measure source: Pan-Canadian Primary Health care Indicator Project: CIHI 2006 Potential data source: Provider-reported Proposed survey question: Have you had a workplace related injury during the past 12 months? Yes No 282

285 Measurement Priority Measure Name Level of reporting Availability Measure description Rating 4.70 Healthy work environments and safety Work-life balance System level Measure not currently available; new required for data collection, analysis and reporting (province/lhin) Percentage of primary care providers who were satisfied with the overall quality of their work-life balance over the past 12 months, by type of provider Numerator Measure source/ Data source /data elements/ Number of providers who were satisfied with the overall quality of work life balance over the past 12 months, by type of provider: FP/GP Nurse practitioner Registered nurse Audiologist Chiropractor Dietitian Occupational therapist Pharmacist Physiotherapist Psychologist Optometrist Social worker Speech-language pathologist Other Each reported separately All respondents Excludes: Don t know Measure source: Pan-Canadian Primary Health care Indicator Project: CIHI 2006 Potential data source: Provider-reported Proposed survey question: Are you satisfied with the overall quality of your work-life balance over the past 12 months? 283 Yes No Don t know

286 Timing and frequency of data release 284

287 Measurement Priority Human resources availability composition (skills mix) and optimized scope of practice Measure Name Level of reporting Availability Measure description Rating 5.00 Team-based primary care practice System level Measure not currently available; new required for data collection, analysis and reporting (province/lhin) Percentage of primary care providers who report practicing with a team Numerator Measure source/ Data source /data elements/ Timing and frequency of data release Number of respondents who reported practicing with a team All respondents Measure source: CIHI Provider survey Potential data source: Provider-reported Survey question: Do you practise with a team (that is, work with other physicians, nurses or other allied health professionals at the same practice site)? yes no 285

288 Measurement Priority Measure Name Level of reporting Availability Measure description Rating 5.00 Human resources availability composition (skills mix) and optimized scope of practice Completeness of the primary care physician team System level Measure not currently available; new required for data collection, analysis and reporting (province/lhin) Percentage of primary care organizations reporting that their primary care physician team is complete DEFINTION & SOURCE INFORMATION Numerator Measure source/ Data source /data elements/ Timing and frequency of data release Number of respondents reporting that their family physician team is complete All respondents Measure source: CIHI Provider survey Potential data source: Organization-reported Survey question: Is your family physician team complete? yes no 286

289 Measurement Priority Measure Name Level of reporting Availability Measure description Rating 4.67 Human resources availability composition (skills mix) and optimized scope of practice Administrative staff complement System level Measure not currently available; new required for data collection, analysis and reporting (province/lhin) Average number of full-time-equivalent administrative staff working in primary care practices Numerator Measure source/ Data source /data elements/ Timing and frequency of data release Number of FTE administrative staff reported by respondents This measure will be reported as some measure of the distribution (e.g., mean, median, percentile) All respondents Measure source: CIHI Organization survey Potential data source: Organization-reported Survey question: How many full-time-equivalent administrative staff (for example, managerial, clerical, reception) currently work at your clinic? 287

290 Measurement Priority Measure Name Level of reporting Availability Measure description Rating 4.78 Human resources availability composition (skills mix) and optimized scope of practice Clinical staff complement System level Measure not currently available; new required for data collection, analysis and reporting (province/lhin) Average number and full-time equivalents of clinical staff working in primary care practices, by clinical discipline Numerator Measure source/ Data source /data elements/ Number and FTEs of clinical staff in the following categories: Nurse practitioner Registered nurse: Audiologist: Chiropractor: Dietitian: Occupational therapist: Physician assistant Psycho-geriatric: Pharmacist: Physiotherapist: Psychologist Optometrist: Social worker: Speech-language pathologist: Respiratory therapist: Other Each measure (number of clinical staff and FTEs) will be reported separately as some measure of the distribution (e.g., mean, median, percentile) All respondents Measure source: CIHI Organization survey Potential data source: Organization-reported Survey question: Please complete the number of staff in your clinic and their FTEs: Nurse practitioner Registered nurse: Audiologist: Chiropractor: 288

291 Dietitian: Occupational therapist: Physician assistant Psycho-geriatric: Pharmacist: Physiotherapist: Psychologist Optometrist: Social worker: Speech-language pathologist: Respiratory therapist: Other Timing and frequency of data release # FTEs 289

292 Measurement Priority Measure Name Level of reporting Availability Measure description Rating 5.00 Human resources availability composition (skills mix) and optimized scope of practice Number of full-time equivalent non-physician health care providers System level Measure currently reported in recommended form (Province/Other provinces/canada/international) Average number of full-time-equivalent non-physician providers working in primary care practices Numerator Measure source/ Data source /data elements/ Timing and frequency of data release Number of non-physician full-time-equivalent health care providers (nurses, therapists or other clinicians) in the practice All respondents Measure source: Commonwealth Fund International Health Policy Survey 2012 Data source: Commonwealth Fund International Health Policy Survey 2012 Survey question: How many non-physician full-time-equivalent health care providers (nurses, therapists or other clinicians) are in your practice? Every three years 290

293 Measurement Priority Measure Name Level of reporting Availability Measure description Rating 5.00 Human resources availability composition (skills mix) and optimized scope of practice Physician complement System level Measure currently reported in recommended form (Province/Other provinces/canada/international) Average number of full-time-equivalent physicians working in primary care practices Numerator Measure source/ Data source /data elements/ Timing and frequency of data release Number of full time equivalent doctors in the practice reported by respondents. All respondents Measure source: Commonwealth Fund International Health Policy Survey 2012 Data source: Commonwealth Fund International Health Policy Survey 2012 Survey question: How many full time equivalent (FTE) doctors, including yourself, are in your practice? Every three years 291

294 Measurement Priority Measure Name Level of reporting Availability Measure description Human resources availability composition (skills mix) and optimized scope of practice Use of locums System level Measure currently reported in recommended form (province) Percentage of primary care physicians who, during the last year: Used any locum tenens Personally provided locum tenens services for another physician Rating 4.43 Numerator Number of respondents who reported that in the last year, they have : used any locum tenens personally provided locum tenens services for another physician Measure source/ Data source /data elements/ Timing and frequency of data release Each reported separately All respondents Measure source: National Physician Survey 2010 (NPS) Data source: National Physician Survey 2010 (NPS) (see comment) Survey question: In the last year, have you: used any locum tenens o yes o no, locum not available o no, locum not needed Personally provided locum tenens services for another physician? o yes o no Annually. (Latest data available in 2010) The NPS is a national physician survey has a limited response rate and so may not be reflective of the entire population of providers. Beginning in 2012, NPS became an annual survey with each survey focusing on key topics that will change over time. 292

295 Measurement Priority Measure Name Level of reporting Availability Measure description Rating 4.78 Human resources availability composition (skills mix) and optimized scope of practice Primary care physicians hours of work per week System level Measure currently reported in recommended form (Province/Other provinces/canada/international) Primary care physicians average hours of medical practice per week Numerator Measure source/ Data source /data elements/ Timing and frequency of data release Total estimated medical practice hours a week that the respondents reported. All respondents Measure name: Commonwealth Fund International Health Policy Survey 2012 Data source: Commonwealth Fund International Health Policy Survey 2012 Survey question: Thinking about your medical practice, estimate how many hours a week you typically work. Every three years 293

296 Measurement Priority Measure Name Level of reporting Availability Measure description Rating 4.56 Human resources availability composition (skills mix) and optimized scope of practice Primary care physicians time in face-to-face contact with patients System level Measure currently reported in recommended form (Province/Other provinces/canada/international) Percentage of time that primary care physicians report spending in face-to-face contact with patients in a typical week Numerator Measure source/ Data source /data elements/ Timing and frequency of data release Percentage of time that respondents report spending on face-toface contacts with patients in a typical week All respondents Measure name: Commonwealth Fund International Health Policy Survey 2012 Data source: Commonwealth Fund International Health Policy Survey 2012 Survey question: In a typical week, about what percentage of time do you spend on face-to-face contacts with patients? Every three years 294

297 Measurement Priority Measure Name Level of reporting Availability Measure description Rating 4.67 Human resources availability composition (skills mix) and optimized scope of practice Size of primary care physician practices System level Measure currently reported in recommended form (Province/Other provinces/canada/international) Average number of patients that primary care physicians report taking care of in their practice. Numerator Measure source/ Data source /data elements/ Timing and frequency of data release The estimated number of patients that the respondent reported currently taking care of in their practice. This measure will be reported as some measure of the distribution (e.g., mean, median, percentile) All respondents Measure name: Commonwealth Fund International Health Policy Survey 2012 Data source: Commonwealth Fund International Health Policy Survey 2012 Survey question: How many patients do you currently take care of in your practice? Every three years 295

298 Measurement Priority Measure Name Level of reporting Availability Measure description Human resources availability composition (skills mix) and optimized scope of practice Use of primary care providers full scope of practice System level Measure not currently available; new required for data collection, analysis and reporting (province/lhin) Percentage of primary care providers who report that, over the course of a year they use: little of their full scope of practice about half of their full scope of practice most of their scope of practice their full scope of practice Rating 4.14 Numerator Number of respondents who reported that over the course of a year they use: little of their full scope of practice about half of their full scope of practice most of their scope of practice their full scope of practice Measure source/ Data source /data elements/ Reported separately All respondents Measure source: CIHI Provider survey Potential data source: Provider-reported Survey question: How much of your scope of practice do you actually use over the course of a year? I use little of my full scope of practice I use about half of my full scope of practice I use most of my full scope of practice I use my full scope of practice Timing and frequency of data release 296

299 Measurement Priority Measure Name Level of reporting Availability Measure description Human resources availability, composition (skills mix) and optimized scope of practice Factors increasing the demand for primary care physicians time System level Measure currently reported in recommended form (province) Percentage of primary care physicians who report that the following factors are increasing the demand for their time at work: Aging patient population Increasing complexity of patient caseload Management of patients with chronic diseases/conditions Increasing patient expectations Increasing administrative workload/paperwork Lack of availability of local/regional physician services in my specialty Lack of availability of local-regional physician services in other specialities Lack of availability of other local/regional health care professional services Medical liability concerns Other None of the above 297 Rating 4.44 Numerator Factors identified by respondents as increasing the demand for their time at work: Aging patient population Increasing complexity of patient caseload Management of patients with chronic diseases/conditions Increasing patient expectations Increasing administrative workload/paperwork Lack of availability of local/regional physician services in my specialty Lack of availability of local-regional physician services in other specialities Lack of availability of other local/regional health care professional services Medical liability concerns Other None of the above Measure source/ Data source /data elements/ Each reported separately All respondents Measure source: National Physician Survey 2010 Data source: National Physician Survey 2010 Survey question: Please indicate which of the following factors are increasing the

300 demand for your time at work. Timing and frequency of data release Aging patient population Increasing complexity of patient caseload Management of patients with chronic diseases/conditions Increasing patient expectations Increasing administrative workload/paperwork Lack of availability of local/regional physician services in my specialty Lack of availability of local-regional physician services in other specialities Lack of availability of other local/regional health care professional services Medical liability concerns Other None of the above Annually. (Latest data available in 2010) The NPS is a national physician survey that has a limited response rate and so may not be reflective of the entire population of providers; additionally data is only available for family physicians and general practitioners and does not include nurse practitioners. Beginning in 2012, NPS became an annual survey with each survey focusing on key topics that will change over time. Measurement Priority Human resources availability, composition (skills mix) and optimized scope of practice Measure Name Primary care providers average weekly work hours - excluding on-call activities - by type of activity Level of reporting System level 298 Availability Measure description Rating 5.00 Numerator Measure currently reported in recommended form (province) Average weekly hours that primary care physicians report spending on the following activities: - Direct patient care without a teaching component - Direct patient care with a teaching component - Teaching/education without direct patient care - Indirect patient care - Health facility committees - Administration - Research - Managing their practice - Continuing medical education/professional development - Other Number of hours in an average week that respondents/physicians reported usually spending on the following activities:

301 Measure source/ Data source /data elements/ - Direct patient care without a teaching component, regardless of setting - Direct patient care with a teaching component, regardless of setting - Teaching education without direct patient care (contact with students/residents, preparation, marking, evaluations, etc.) - Indirect patient care (charting, reports, phone calls, meeting patients' family, etc.) - Health facility committees (academic planning committees) - Administration (i.e., management of university program, chief of staff, department head, Ministry of Health, etc.) - Research (including management of research and publications) - Managing your practice (staff, facility, equipment, etc.) - Continuing medical education/professional development (courses, reading, videos, tapes, seminars, etc.) - Other (participation in professional or specialty organizations, medico-legal activities, etc.) Each reported separately as some measure of the distribution (e.g., mean, median, percentile) All respondents Measure source: National Physician Survey 2010 Data source: National Physician Survey 2010 Survey question: Excluding on-call activities, how many hours in an average week do you usually spend on the following activities? (Assume each activity is mutually exclusive for reporting purposes, i.e. if an activity spans two categories; please report hours in only one category.) Direct patient care without a teaching component, regardless of setting Direct patient care with a teaching component, regardless of setting Teaching education without direct patient care (contact with students/residents, preparation, marking, evaluations, etc.) Indirect patient care (charting, reports, phone calls, meeting patients' family, etc.) Health facility committees (academic planning committees) Administration (i.e., management of university program, chief of staff, department head, Ministry of Health, etc.) Research (including management of research and publications) Managing your practice (staff, facility, equipment, etc.) Continuing medical education/professional development (courses, reading, videos, tapes, seminars, etc.) Other (participation in professional or specialty organizations, medico-legal activities, etc.) 299

302 please specify: Timing and frequency of data release Annually. (Latest data available in 2010) The NPS is a national physician survey that has a limited response rate and so may not be reflective of the entire population of providers; additionally data is only available for family physicians and general practitioners and does not include nurse practitioners. Beginning in 2012, NPS became an annual survey with each survey focusing on key topics that will change over time. 300

303 Measurement Priority Measure Name Level of reporting Availability Measure description Rating 4.44 Human resources availability, composition (skills mix) and optimized scope of practice Frequency of use and impact of continuing professional education methods System level Measure currently reported in recommended form (province) Average frequency of use and impact on primary care physicians practices of their continuing professional education activities Numerator Number of respondents who reported the frequency of use and impact of the following continuing professional education methods on their practice: Attending live accredited conferences, courses or events in person Attending live unaccredited conferences, courses or events in person Reading peer-reviewed journals Reading non peer-reviewed medical publications Using evidence-based resources (e.g., clinical practice guidelines, data repositories) Using computer-based, offline education (e.g., CD-ROM, DVD) Using internet-based education /elearning (e.g., online courses, webinars) Participating in hospital/clinical rounds, journal clubs and other small group activities Doing self-assessment activities (e.g., multiple choice questions, practice portfolios, CME logs, multi-source feedback) Undergoing practice audits Using stimulation (e.g., full/partial task simulators, virtual reality, standardized patients, role play) Other, please specify: Based on the following scale: Frequency: 1=never 2=once a year 3=once every six months 4=once a month 5=more than once a month 301 Impact: 1=very insignificant 2= somewhat insignificant 3=neutral

304 4=somewhat significant 5= very significant DU=don t use Measure source/ Data source /data elements/ Each measure (frequency of use and impact) will be reported separately with some pre-defined value or cut-off All respondents Measure source: National Physician Survey 2010 Data source: National Physician Survey 2010 Survey question: Please indicate the frequency of use and impact of the following continuing professional education methods: Attending live accredited conferences, courses or events in person Attending live unaccredited conferences, courses or events in person Reading peer-reviewed journals Reading non peer-reviewed medical publications Using evidence-based resources (e.g., clinical practice guidelines, data repositories) Using computer-based, offline education (e.g., CD-ROM, DVD) Using internet-based education /elearning (e.g., online courses, webinars) Participating in hospital/clinical rounds, journal clubs and other small group activities Doing self-assessment activities (e.g., multiple choice questions, practice portfolios, CME logs, multi-source feedback) Undergoing practice audits Using stimulation (e.g., full/partial task simulators, virtual reality, standardized patients, role play) Other, please specify: 302 Frequency: 1=never 2=once a year 3=once every six months 4=once a month 5=more than once a month Impact: 1=very insignificant 2= somewhat insignificant 3=neutral 4=somewhat significant 5= very significant DU=don t use

305 Timing and frequency of data release Annually (Latest data available in 2010) The NPS is a national physician survey that has a limited response rate and so may not be reflective of the entire population of providers; additionally data is only available for family physicians and general practitioners and does not include nurse practitioners. Beginning in 2012, NPS became an annual survey with each survey focusing on key topics that will change over time. 303

306 Measurement Priority Measure Name Level of reporting Availability Measure description Rating* Numerator Measure source/ Data source /data elements/ Human resources availability, composition (skills mix) and optimized scope of practice Organizational support for primary care providers to participate in continuing professional development, by type of primary care provider System level Measure not currently available; new required for data collection, analysis and reporting (province/lhin) Percentage of primary care providers who report that their organization provides them with support (financial, time, other) to participate in continuing professional development, by type of provider Number of respondents who reported that their organization provides them with support (financial, time, other) to participate in continuing professional development, by type of primary care provider: GP/FP NP RN OT PT Pharmacist Other professionals- specify (i.e., dietician, psychologist, chiropodist, etc.) All respondents Excludes: Not sure Decline to answer Measure source: Modified - Program Evaluation Framework: Alberta Potential data source: Provider-reported Proposed survey question: Does your organization provides you with support (financial, time, and other) to participate in continuing professional development in the last year? Yes No Not sure Decline to answer 304 For reporting by physician type: To which of the following categories do you belong?

307 Timing and frequency of data release GP/FP, NP, RN, OT, PT, Pharmacist, and Other professionals- specify (i.e., dietician, psychologist, chiropodist, etc.). *This measure was not rated as it was identified after the rating process Measurement Priority Measure Name Level of reporting Availability Measure description Rating* Numerator Measure source/ Data source /data elements/ Timing and frequency of data release Practice improvement and planning Primary care providers involvement in quality improvement initiatives System level Measure not currently available; new required for data collection, analysis and reporting (province/lhin) Percentage of primary care providers who report that they are involved in quality improvement initiatives in their practice Regularly Infrequently Number of primary care providers who reported being involved in any quality improvement initiatives in their practice All respondents Measure source: CIHI - Provider Survey Potential data source: Provider-reported Survey question: Are you involved in any quality improvement initiatives in your practice? Yes, regularly Yes, infrequently No, but plan to be soon No TWG recommends specific quality improvement initiatives be specified in the question. 305

308 *This measure was not rated as it was identified after the rating process Measurement Priority Practice improvement and planning Measure Name Level of reporting Availability Measure description Rating* Numerator Measure source/ Data source /data elements/ Primary care providers who routinely receive and review the data on their patient care System level Measure currently available but modified wording recommended (Province/Other provinces/canada/international) Percentage of primary care physicians who report that their practice routinely receives and reviews data on the following aspects of their patients care: clinical outcomes surveys of patient satisfaction and experiences with care patients hospital admissions or emergency department use the frequency of ordering diagnostic tests; the frequency of various conditions the frequency of referrals to specialists/specialized services Number of primary care providers who report their practice routinely receives and reviews data on the following aspects of their patient s care: Clinical outcomes (e.g., percent of diabetics or asthmatics with good control) Surveys of patient satisfaction and experiences with care Patients hospital admissions or emergency department use The frequency of ordering diagnostics tests The frequency of various conditions/diagnoses The frequency of referrals to specialists/specialized services Each reported separately All respondents Excludes: Not sure Decline to answer Measure source: Modified - Commonwealth Fund International Health Policy Survey 2012 Potential data source: Provider-reported 306

309 Proposed survey question: Does the place where you practice routinely receive and review data on the following aspects of your patients care? Clinical outcomes (e.g., percent of diabetics or asthmatics with good control) Surveys of patient satisfaction and experiences with care Patients hospital admissions or emergency department use The frequency of ordering diagnostics tests The frequency of various conditions The frequency of referrals to specialists/specialized services yes no Not sure Decline to answer Original survey question: Does the place where you practice routinely receive and review data on the following aspects of your patients care? Clinical outcomes (e.g., percent of diabetics or asthmatics with good control) Surveys of patient satisfaction and experiences with care Patients hospital admissions or emergency department use The frequency of ordering diagnostics tests. Timing and frequency of data release yes no Not sure Decline to answer Every three years *This measure was not rated as it was identified after the rating process 307

310 Measurement Priority Practice improvement and planning Measure Name Level of reporting Availability Measure description Rating* Numerator Review of clinical performance against targets System level Measure currently reported in recommended form (Province/Other provinces/canada/international) Percentage of primary care physicians who report that they review some areas of clinical performance against targets, at least annually Number of primary care providers who report that they review some areas of their clinical performance against targets at least annually All respondents Measure source/ Data source /data elements/ Timing and frequency of data release Excludes: Not sure Decline to answer Measure source: Commonwealth Fund International Health Policy Survey 2012 Data source: Commonwealth Fund International Health Policy Survey 2012 Survey question: Are any areas of clinical performance reviewed against targets at least annually? Yes No Not sure Decline to answer Every three years *This measure was not rated as it was identified after the rating process 308

311 Measurement Priority Practice improvement and planning Measure Name Level of reporting Availability Measure description Rating* Comparison clinical performance to the performance of other practices System level Measure currently reported in recommended form (Province/Other provinces/canada/international) Percentage of primary care physicians who report that they receive information on how the clinical performance of their practice compares to other practices: Routinely Occasionally Numerator Number of primary care providers who reported that they routinely or occasionally receive information on how the clinical performance of their practice compares to other practices All respondents Measure source/ Data source /data elements/ Timing and frequency of data release Excludes: Not sure Decline to answer Measure source: Commonwealth Fund International Health Policy Survey 2012 Data source: Commonwealth Fund International Health Policy Survey 2012 Survey question: Do you receive information on how the clinical performance of your practice compares to other practices? Would you say Yes, routinely Yes, occasionally No Not sure Decline to answer Every three years *This measure was not rated as it was identified after the rating process 309

312 Measurement Priority Practice improvement and planning Measure Name Level of reporting Availability Measure description Rating* Community input for planning primary care services System level Measure not currently available; new required for data collection, analysis and reporting (province/lhin) Percentage of primary care organizations reporting that they have processes to obtain community input for planning the organization s services Numerator Number of PHC organizations who currently have processes to obtain community input into planning the organization s services (e.g. advisory committees, focus groups) All respondents Measure source/ Data source /data elements/ Timing and frequency of data release Excludes: Not sure Decline to answer Measure source: Pan - Canadian Primary Health Care Indicator Project: CIHI 2006 Potential data source: Organization-reported Proposed survey question: Does your primary care organization have processes to obtain community input for planning the organization s services (e.g. advisory committees, focus groups)? Yes No Not sure Declined to answer *This measure was not rated as it was identified after the rating process 310

313 Measurement Priority Practice improvement and planning Measure Name Level of reporting Availability Measure description Rating* Changes in clinical practice as a result of quality improvement initiatives System level Measure not currently available; new required for data collection, analysis and reporting (province/lhin) Percentage of primary care organizations reporting that they implemented one or more changes in clinical practice as a result of quality-improvement initiatives during the past 12 months Numerator Number of primary care organizations that implemented at least one or more changes in clinical practice as a result of quality improvement initiatives over the past 12 months Number of primary health care organization survey with quality initiatives implemented In the past 12 months Measure source/ Data source /data elements/ Base (respondents who answered yes): Did your organization implement quality initiative in the past 12 months Excludes: Not sure Decline to answer Measure source: Pan - Canadian Primary Health Care Indicator Project: CIHI 2006 Potential data source: Organization-reported Proposed survey question: Did your organization make one or more changes to your clinical practice as a result of quality improvement initiatives over the past 12 months? Yes, No Don t know Decline to answer Timing and frequency of data release *This measure was not rated as it was identified after the rating process 311

314 Measurement Priority Comprehensive scope of practice Measure Name Level of reporting Availability Measure description Rating* Primary care physicians providing comprehensive care System level Measure currently reported in recommended form (province/lhin) Percentage of primary care physicians who provide a broad scope of primary care physician services Numerator Number of GP/FPs that comply with any of the following criteria: working in PEMs not working in PEMs and not in focused practice but billing 7 or more activity areas Activity areas: Mini/minor assessments General assessments/re-assessments Intermediate assessments Annual health exam child Geriatric care Primary mental health care Hospital care House calls Chronic care/long-term care visits Emergency department or equivalent Vision care Palliative care Flu shots Other immunization Office lab procedures Allergy shots Other injections Pap smears Anticoagulant therapy Pre-operative assessment Diabetes management Smoking secession Physicians with functional status as GP/FP 312

315 Excludes: GP/FPs in focused practice GP/FPs who did not work at least 1 day a week Measure source/ Data source /data elements/ Timing and frequency of data release Measure source: ICES Data source: OHIP, provided by ICES Potentially available annually *This measure was not rated as it was identified after the rating process 313

316 Appendix 14: Recommended Population Characteristics for Assessing Primary Care Equity Measures in Existing Data Sources Age Recommended Measures Administrative data Survey data Administrative data Survey data Registered Persons Database (RPDB) BDATE Birth date on RPDB Canadian Institute for Health Information- Discharge Abstract Database (CIHI- DAD) AGE Age in years AGECAT Age category AGEGR Age group Canadian Community Health Survey (CCHS) ANDB_Q01 What is [patients name] s age? _ _ _ Age in years (MIN: 0) (MAX: 130) (DK, RF are not allowed) Health Care Experience Survey (MOHLTC) Sociodemographics: yr_birth In what year were you born? enter year Don t know Refuse Registered Persons Database (RPDB) BDATE Birth date on RPDB Canadian Institute for Health Information- Discharge Abstract Database (CIHI-DAD) AGE Age in years AGECAT Age category AGEGR Age group In what year were you born? Measures in Existing Data Sources Gender / Sex Recommended Measures Administrative data Survey data Administrative data Survey data 314

317 Registered Persons Database (RPDB) SEX Sex listed on RPDB Canadian Institute for Health Information- Discharge Abstract Database (CIHI- DAD) SEX Sex listed on CIHI-DAD Canadian Community Health Survey (CCHS) SEX_Q01 Enter [patients name] s sex. 1 Male 2 Female (DK, RF are not allowed) Health Care Experience Survey (MOHLTC) Warm-up Questions: Enter respondent's gender please 1 Male 5 Female d Don't know Registered Persons Database (RPDB) SEX Sex listed on RPDB Canadian Institute for Health Information- Discharge Abstract Database (CIHI-DAD) SEX Sex listed on CIHI-DAD What is your gender? Female Intersex Male Trans-female to male Trans-male to female Other Prefer not to answer Don t know Source: Toronto Central LHIN Equity Core & Optional Questions Note: This question was taken from a pilot survey and will be updated pending feedback. Urban/rural location Measures in Existing Data Sources Recommended Measures Administrative data Survey data Administrative data Survey data 315 Statistics Canada (based on postal code) Metropolitan Area and Census Agglomeration Influenced Zones (MIZ) 1 =Census Metropolitan Area (CMA)/Census Agglomeration (CA); 2 = Strong MIZ; 3 = Moderate MIZ; 4 = Weak MIZ; 5 = No MIZ Statistics Canada Census subdivisions Statistics Canada (based on postal code) Metropolitan Area and Census Agglomeration Influenced Zones (MIZ) 1 =Census Metropolitan Area (CMA)/Census Agglomeration (CA); 2 = Strong MIZ; 3 = Moderate MIZ; 4 = Weak MIZ; 5 = No MIZ Census subdivisions (CSDs) outside CMAs and CAs are classified into one of four categories listed below according to the degree of influence that CMAs and CAs have on them. CSDs are assigned to one (based on postal code) Metropolitan Area and Census Agglomeration Influenced Zones (MIZ) 1 =Census Metropolitan Area (CMA)/Census Agglomeration (CA); 2 = Strong MIZ; 3 = Moderate MIZ; 4 = Weak MIZ; 5 = No MIZ Census subdivisions (CSDs) outside CMAs and CAs are classified into one (based on postal code) Metropolitan Area and Census Agglomeration Influenced Zones (MIZ) 1 =Census Metropolitan Area (CMA)/Census Agglomeration (CA); 2 = Strong MIZ; 3 = Moderate MIZ; 4 = Weak MIZ; 5 = No MIZ Census subdivisions (CSDs) outside CMAs and CAs are classified into one of four categories listed

318 (CSDs) outside CMAs and CAs are classified into one of four categories listed below according to the degree of influence that CMAs and CAs have on them. CSDs are assigned to one of the following categories based on the percentage of their resident employed labour force that work in the urban core of any CMA and CA: Strongly influenced at 30% or more Moderately influenced at more than 5% but less than 30% Weakly influenced at more than 0% but less than 5% Not influenced at 0% of the following categories based on the percentage of their resident employed labour force that work in the urban core of any CMA and CA: Strongly influenced at 30% or more Moderately influenced at more than 5% but less than 30% Weakly influenced at more than 0% but less than 5% Not influenced at 0% of four categories listed below according to the degree of influence that CMAs and CAs have on them. CSDs are assigned to one of the following categories based on the percentage of their resident employed labour force that work in the urban core of any CMA and CA: Strongly influenced at 30% or more Moderately influenced at more than 5% but less than 30% Weakly influenced at more than 0% but less than 5% Not influenced at 0% Source: Statistics Canada below according to the degree of influence that CMAs and CAs have on them. CSDs are assigned to one of the following categories based on the percentage of their resident employed labour force that work in the urban core of any CMA and CA: Strongly influenced at 30% or more Moderately influenced at more than 5% but less than 30% Weakly influenced at more than 0% but less than 5% Not influenced at 0% Source: Statistics Canada Measures in Existing Data Sources Ethno-cultural Identify Recommended Measures Administrative data Survey data Administrative data Survey data Not generally available in administrative 316 Canadian Community Health Survey (CCHS) SDC_Q4A To which Use measure from linked survey when To which ethnic or cultural groups did your ancestors

319 data except when linked at the individual level to survey data (e.g., CCHS) ethnic or cultural groups did your ancestors belong? 01 Canadian 02 French 03 English 04 German 05 Scottish 06 Irish 07 Italian 08 Ukrainian 09 Dutch (Netherlands) 10 Chinese 11 Jewish 12 Polish 13 Portuguese 14 South Asian (e.g. East Indian, Pakistani, Sri Lankan) 15 Norwegian 16 Welsh 17 Swedish 18 First Nations (North American Indian) 19 Métis 20 Inuit 21 Other - Specify (Go to SDC_S4A) DK, RF available belong? 01 Canadian 02 French 03 English 04 German 05 Scottish 06 Irish 07 Italian 08 Ukrainian 09 Dutch (Netherlands) 10 Chinese 11 Jewish 12 Polish 13 Portuguese 14 South Asian (e.g. East Indian, Pakistani, Sri Lankan) 15 Norwegian 16 Welsh 17 Swedish 18 First Nations (North American Indian) 19 Métis 20 Inuit 21 Other - Specify (Go to SDC_S4A) DK, RF Source: CCHS Measures in Existing Data Sources Disability Recommended Measures Administrative data Survey data Administrative data Survey data 317

320 Not generally available in administrative data except when linked at the individual level to survey data (e.g., CCHS) Canadian Community Health Survey (CCHS) Activity-limiting disability: Number of activities that are limited because of individual s long-term physical or mental condition or health problem, out of the following 4 kinds of activity: 1) at home, 2) at school, 3) at work, 4) other activities such as transportation to or from work or leisure time activities Use measure from linked survey when available Activity-limiting disability: Number of activities that are limited because of individual s long-term physical or mental condition or health problem, out of the following 4 kinds of activity: 1) at home, 2) at school, 3) at work, 4) other activities such as transportation to or from work or leisure time activities RAC_Q2A RAC_2A INTERVIEWER: Read categories to respondent. Does a long-term physical condition or mental condition or health problem, reduce the amount or the kind of activity ^YOU1 can do:... at home? 1 Sometimes 2 Often 3 Never DK RF (Go to RAC_END) RAC_Q2B_1 RAC_2B1 (Does a long-term physical condition or mental condition or health problem, reduce the amount or the kind of activity ^YOU1 can do:)... at school? 1 Sometimes 2 Often RAC_Q2A RAC_2A INTERVIEWER: Read categories to respondent. Does a long-term physical condition or mental condition or health problem, reduce the amount or the kind of activity ^YOU1 can do:... at home? 1 Sometimes 2 Often 3 Never DK RF (Go to RAC_END) RAC_Q2B_1 RAC_2B1 (Does a long-term physical condition or mental condition or health problem, reduce 318

321 3 Never 4 Does not attend school DK RF (Go to RAC_END) RAC_Q2B_2 RAC_2B2 (Does a long-term physical condition or mental condition or health problem, reduce the amount or the kind of activity ^YOU1 can do:)... at work? 1 Sometimes 2 Often 3 Never 4 Does not work at a job DK RF (Go to RAC_END) RAC_Q2C RAC_2C (Does a long-term physical condition or mental condition or health problem, reduce the amount or the kind of activity ^YOU1 can do:)... in other activities, for example, transportation or leisure? 1 Sometimes 2 Often 3 Never DK RF (Go to RAC_END) the amount or the kind of activity ^YOU1 can do:)... at school? 1 Sometimes 2 Often 3 Never 4 Does not attend school DK RF (Go to RAC_END) RAC_Q2B_2 RAC_2B2 (Does a long-term physical condition or mental condition or health problem, reduce the amount or the kind of activity ^YOU1 can do:)... at work? 1 Sometimes 2 Often 3 Never 4 Does not work at a job DK RF (Go to RAC_END) RAC_Q2C RAC_2C (Does a long-term physical condition or mental condition or health problem, reduce the amount or the kind of activity ^YOU1 can do:)... in other activities, for example, transportation or 319

322 leisure? 1 Sometimes 2 Often 3 Never DK RF (Go to RAC_END) Source: CCHS Measures in Existing Data Sources Social support Recommended Measures Administrative data Survey data Administrative data Survey data 320

323 Not generally available in administrative data except when linked at the individual level to survey data (e.g., CCHS) Canadian Community Health Survey (CCHS) SPS_R01 (optional) - The next questions are about your current relationships with friends, family members, co-workers, community members, and so on. Please indicate to what extent each statement describes your current relationships with other people. Use measure from linked survey when available The next questions are about your current relationships with friends, family members, coworkers, community members, and so on. Please indicate to what extent each statement describes your current relationships with other people. 321 There are people I can depend on to help me if I really need it. There are people who enjoy the same social activities I do. I have close relationships that provide me with a sense of emotional security and wellbeing. There is someone I could talk to about important decisions in my life. I have relationships where my competence and skill are recognized. There is a trustworthy person I could turn to for advice if I were having problems. I feel part of a group of people who share my attitudes and beliefs. I feel a strong emotional bond with at least one other person. There are people who admire my talents and abilities. There are people I can count on in an emergency. There are people I can depend on to help me if I really need it. There are people who enjoy the same social activities I do. I have close relationships that provide me with a sense of emotional security and wellbeing. There is someone I could talk to about important decisions in my life. I have relationships where my competence and skill are recognized. There is a trustworthy person I could turn to for advice if I were having problems. I feel part of a group of people who share my attitudes and beliefs.

324 1 Strongly agree 2 Agree 3 Disagree 4 Strongly disagree DK, RF The variable SPSDCON, based on responses to the items above, is used to measure the overall score for the Social Provisions Scale. The score is calculated by inverting the scores to each of the items and adding them. The range is 10-40, where a higher score reflects a higher level of perceived social support. Measures in Existing Data Sources Income I feel a strong emotional bond with at least one other person. There are people who admire my talents and abilities. There are people I can count on in an emergency. 1 Strongly agree 2 Agree 3 Disagree 4 Strongly disagree DK, RF The variable SPSDCON, based on responses to the items above, is used to measure the overall score for the Social Provisions Scale. The score is calculated by inverting the scores to each of the items and adding them. The range is 10-40, where a higher score reflects a higher level of perceived social support. Source: CCHS Recommended Measures Administrative data Survey data Administrative data Survey data 322

325 323 Neighbourhood /household income quintile based on Census data and postal code Registered Persons Database (RPDB) Using Incquint Income quintile variable, from RPDB Average neighbourhood income is calculated by Statistics Canada and is updated every five years when new Census data become available. Income is calculated using the neighbourhood income per person equivalent (IPPE), which is a household size adjusted measure of household income based on 2006 census summary data at the dissemination area level and using personequivalents implied by the 2006 low income cut-offs. Average income estimates Health Care Experience Survey (MOHLTC) inc1. Could you please tell me how much income you and other members of your household received in the year ending December 31st 2012, before taxes. Please include income from all sources such as savings, pensions, rent, as well as wages. To the nearest thousand dollars, what was your total household income before taxes and other deductions were made? 0 less than one thousand dollars enter amount (2 for $2,000, 20 for $20,000, 120 for $120,000, etc.) d don't know r refused Canadian Community Health Survey (CCHS) INC_Q5A Can you estimate which of the following groups your household income falls? Was the total household income in the past 12 months...? following questions sort income into categories: INC_5Bless than $5,000 to less than $50,000; INC_5Cmore than $50,000 to $150,000 and over Neighbourhood /household income quintile based on Census data Registered Persons Database (RPDB) Incquint - Income quintile variable, from RPDB Average neighbourhood income is calculated by Statistics Canada and is updated every five years when new Census data become available. Income is calculated using the neighbourhood income per person equivalent (IPPE), which is a household size adjusted measure of household income based on 2006 census summary data at the dissemination area level and using personequivalents implied by the 2006 low income cut-offs. Average income estimates were calculated by dissemination area. Ontario Which of the following income groups would best represent your annual HOUSEHOLD income? Less than $10,000 $10,000 to less than $20,000 $20,000 to less than $40,000 $40,000 to less than $60,000 $60,000 to less than $80,000 $80,000 to less than $100,000 $100,000 to less than $120,000 $120,000 to less than $140,000 More than $140,000 Source: Practice-Level Patient Experience Survey (HQO)(under development)

326 were calculated by dissemination area. Ontario neighbourhoods are classified into quintiles, ranked from poorest (Q1) to wealthiest (Q5). Postal codes are used to assign people to enumerations areas or dissemination areas (using the Statistics Canada Postal Code Conversion File) and thus to one of the income quintiles. neighbourhoods are classified into quintiles, ranked from poorest (Q1) to wealthiest (Q5). Postal codes are used to assign people to enumerations areas or dissemination areas (using the Statistics Canada Postal Code Conversion File) and thus to one of the income quintiles. Measures in Existing Data Sources Education Recommended Measures Administrative data Survey data Administrative data Survey data 324 Not generally available in administrative data except when linked at the individual level to survey data (e.g., CCHS, HCES) Health Care Experience Survey (MOHLTC) Edu. What is the highest level of education you have completed to date? 1 less than high school 2 some high school 3 high school graduate or equivalent 4 some community college, technical, trade, or vocational college 5 completed community college, technical, trade, or vocational college Use measure from linked survey when available What is the highest level of schooling that you have completed? Less than elementary school Elementary School High School Community College Some University Completed University Graduate Degree Source: Practice-Level Patient Experience Survey (HQO)(under

327 6 some university but no degree 7 completed bachelor's degree (Arts, Science, Eng, etc.) 8 post graduate training: MA, MSc, MLS, MSW, MBA, etc. 9 post graduate training: PhD, "doctorate" 10 professional degree (Law, Medicine, Dentistry) d don't know r refused development) 325 Canadian Community Health Survey (CCHS) For patients aged 14 and older EDU1_Q04A What is the highest certificate, diploma, or degree that you have completed? 1 Less than high school diploma or its equivalent 2 High school diploma or a high school equivalency certificate training 3 Trade Certificate or Diploma 4 College, cegep or other non-university certificate or diploma (other than trades certificates or diplomas) 5 University certificate or diploma below the bachelor s level 6 Bachelor s degree (eg. B.A., B.Sc., LL.B.)

328 7 University certificate, diploma or degree above the bachelor s level DK, RF Measures in Existing Data Sources Sexual Orientation/Identity Recommended Measures Administrative data Survey data Administrative data Survey data Not generally available in administrative data except when linked at the individual level to survey data (e.g., CCHS) Canadian Community Health Survey (CCHS) SDC_Q7B Do you consider yourself to be? 1. heterosexual (sexual relations with people of the opposite sex) 2. homosexual, that is lesbian or gay (sexual relations with people of your own sex) 3. bisexual (sexual relations with people of both sexes DK, RF5B Use measure from linked survey when available What is your sexual orientation? Bisexual Gay Heterosexual ( straight ) Lesbian Queer Two-spirit Other Prefer not to answer Don t know Source: Toronto Central LHIN Equity Core and Optional Questions Note: This question was taken from a pilot survey and will be updated pending feedback. Measures in Existing Data Sources Language Recommended Measures Administrative data Survey data Administrative data Survey data 326 Not generally available in administrative data except when linked at the individual level to survey data (e.g., Health Care Experience Survey (MOHLTC) lang_home. What language do you speak most often at home? 1 English 2 French Use measure from linked survey when available What language would you feel most comfortable speaking in with your healthcare provider? American Sign Language

329 CCHS, HCES) 3 English & French 4 English & other 5 Czech 6 Croatian 7 Danish 8 Dutch 9 German 10 Greek 11 Hungarian 12 Italian 13 Polish 14 Portuguese 15 Russian 16 Spanish 17 Ukrainian 18 Yugoslavian 19 Other European language 20 African language 21 Chinese (Mandarin or Cantonese) 22 Filipino or Tagalog 23 Vietnamese 24 Other Asian language 25 Hindi 26 Punjabi 27 Tamil 28 Urdu 29 Other East Indian language 30 Hispanic languages 31 Arabic 32 Other Middle Eastern languages 33 Native & Aboriginal languages 0 Other, specify 97 Not codeable 98 Don t know 99 Refused Canadian Community Health Survey (CCHS) SDC_B5B What language do you speak Arabic Bengali Chinese (Cantonese) Chinese (Mandarin) Cree Dari English French German Greek Gujarati Hebrew Hindi Hungarian Italian Korean Ojibwe Oji-Cree Farsi (Persian) Polish Portuguese Punjabi Russian Spanish Somali Tagalog Tamil Urdu Vietnamese Other (please specify) Prefer not to answer Do not know Source: Toronto Central LHIN Equity Core and Optional Questions Note: This question was taken from a pilot survey and will be updated pending feedback. 327

330 most often at home? The patients can give up to three responses. Measures in Existing Data Sources Immigration Recommended Measures Administrative data Survey data Administrative data Survey data Ontario Health Insurance Plan Claims Database Recent OHIP registrants Citizenship and Immigration database (CIC) linked file at ICES Canadian Community Health Survey (CCHS) SDC_Q3 - In what year did ^YOU1 first come to Canada to live? User enters the year or approximate year if he/she cannot give the exact year Ontario Health Insurance Plan Claims Database Recent OHIP registrants or Citizenship and Immigration database (CIC) linked file at ICES SDC_Q3 - In what year did ^YOU1 first come to Canada to live? User enters the year or approximate year if he/she cannot give the exact year Source: CCHS Measures in Existing Data Sources Aboriginal Status Recommended Measures Administrative data Survey data Administrative data Survey data Measures in Existing Data Sources Employment Status Recommended Measures Administrative data Survey data Administrative data Survey data 328 Not generally available in administrative data except when linked at the individual level to survey data (e.g., CCHS, ) Canadian Community Health Survey (CCHS) GEN_08 - Have you worked at a job or business at any time in the past 12 months? 1 Yes 2 No DK, RF Use measure from linked survey when available Last week, did ^YOU2 work at a job or a business? Please include part time jobs, seasonal work, contract work, self-employment, baby-sitting and any other paid work, regardless of the number

331 LBS_01 - Last week, did ^YOU2 work at a job or a business? Please include part time jobs, seasonal work, contract work, self-employment, baby-sitting and any other paid work, regardless of the number of hours worked. 1 Yes 2 No 3 Permanently unable to work DK, RF DK, RF of hours worked. 1 Yes 2 No 3 Permanently unable to work DK, RF DK, RF Source: CCHS 329